BLOOMINGTON — Heroin has moved from back alleys to the family room.
"It's in everyone's backyard," said Tamara Childress, director of mental health for Bloomington-based Chestnut Health Systems. Sixty percent of clients treated in Chestnut's crisis stabilization unit are dependent on heroin or another opioid, she said.
"It's happening everywhere," agreed Dr. Darrell Rust, an emergency department physician at OSF Saint James-John W. Albrecht Medical Center, Pontiac, and medical director of Chestnut's crisis unit.
At Saint James's emergency department, two to three patients are treated a week for a heroin addiction, Rust said. Some have overdosed, some are having difficult withdrawal symptoms and others have complications, such as infections from using dirty needles.
"I have been an emergency department physician for 30 years and I've seen more heroin problems in the last five years than I have the previous 25," he said.
"These are not homeless, skid row junkies," Rust said. "They are our neighbors, caught up in a terrible problem."
The crisis took center stage last week when it was learned that pop icon Prince had died of an accidental overdose of fentanyl, an opioid up to 50 times more potent than heroin.
"There are 525,000 to 600,000 people (nationwide) who are actively using heroin, meaning in the past month," said Mark Godley, Chestnut senior scientist. "I don't know how many are abusing all opioids."
According to the U.S. Centers for Disease Control and Prevention, drug overdose was the leading cause of accidental death in the country in 2014 with 47,055 lethal drug overdoses. Opioid addiction is driving the epidemic, with 18,893 overdose deaths related to prescription pain relievers and another 10,574 overdose deaths related to heroin.
Throughout Central Illinois, thousands of people are treated each year for addiction to opioids, including heroin, and hundreds end up in hospitals.
At Advocate BroMenn Medical Center, 258 people were treated for opioid addiction during 2015 and 92 from Jan. 1 through May 16 this year, said Lori Ritter, trauma quality coordinator in Advocate BroMenn's emergency department.
McLean County Area EMS providers administered Naloxone (Narcan) 134 times in 2015 to people experiencing an opioid overdose, said EMS Director Dylan Ferguson. So far this year, Naloxone administrations are up 31 percent, he said.
"Usually, when someone has overdosed on an opioid, we find them unconscious and not breathing or breathing shallowly," Ferguson said. In addition to restoring breathing, paramedics or EMTs administer Naloxone to reverse the overdose.
"Typically, within 60 to 90 seconds, the patient will begin breathing on his own again and will become fully conscious," Ferguson said.
"Heroin just ruins peoples' lives," said Joe Vaughan, executive director of IHR (Institute for Human Resources) Counseling Services, Livingston County's mental health and substance abuse agency.
"We serve 400 to 500 people in our substance abuse program and 150 of them" use heroin or another opioid, Vaughan said.
Addiction is quick
The opioid epidemic is different from other prior drug epidemics.
First, heroin and other opioids give people quick relief and it's easier to become addicted to opioids than other drugs, Vaughan said.
"A person can become addicted within weeks rather than months or years," said Ed Betzelberger, director of addiction services for Tazwood Center for Wellness that provides mental health services in Tazewell, Woodford and Logan counties.
The second difference is the avenue to heroin. Most people begin by using prescription pain killers.
"Every heroin addict I have worked with has said they never believed they would do heroin," Betzelberger said.
The heroin epidemic is rooted, in part, in over-prescription of opioids painkillers beginning in the mid-1990s, said Sandra Beecher and Brittany Ott of Unity Point Health and the Illinois Institute for Addiction Recovery at Advocate BroMenn.
"OxyContin (a prescription opioid painkiller) came on the market in mid-1990s," said Godley, noting in 1996, 94 million painkiller prescriptions were written in the U.S. By 2013, that number was 207 million.
Frequently, addiction begins with a well-intended effort to control pain following an injury or surgery, said substance abuse treatment providers.
The medical community had been criticized for not doing enough to control patients' pain, said Rust, but some doctors prescribed too many pain killers.
Some people who enjoyed the high continued to take the prescription pain killers after no longer needing them to control pain. Some sold it or gave it to others — or it was stolen by others — who used it to get high rather than controlling pain.
When the prescriptions weren't refilled, some people who had been addicted turned to buying an illegal opioid — heroin — on the street. Heroin is cheaper than prescription pain killers and is available in large quantities.
Eighty percent of heroin users report using opioid prescriptions non-medically prior to heroin use, Beecher and Ott said.
"Some people start by snorting a powder form," Betzelberger said. Then, IV use becomes the preferred method because it's injected directly into the blood stream so users get high quicker.
"Opioids react with nerve cells in the brain and nervous system to produce pleasurable effects and relieve pain," Godley said. "It's more addicting than other drugs. It happens quite fast and the withdrawal is a painful process."
The withdrawal, described as a severe and painful flu, is another reason people stay addicted to heroin.
While heroin is dangerous, what's even more dangerous is how it's cut.
Sometimes, heroin is laced with fentanyl, which increases the risk of overdose, Beecher and Ott said. Fentanyl, the drug Prince took, is much more powerful than heroin, added Ralph Weisheit, Illinois State University professor of criminal justice sciences.
"Anytime you mix medications together, it's going to have a more pronounced, dangerous effect," Betzelberger said.
"Even a recreational user can OD if it's cut with fentanyl," Weisheit said.
The effect is slowing the body down to the point that people lose consciousness and in some cases stop breathing.
But even people who don't overdose experience compromised health, including HIV from sharing needles and a decline in mental health as their addiction takes over their life.
Addiction results in a rewiring of the brain, Betzelberger said. People lose interest in activities they once enjoyed and their personalities change.
Half of the people contemplating suicide last year who were assisted by the crisis team of Center for Human Services (CHS) of McLean County had attempted suicide using heroin or another opioid, said crisis program manager Meghan Moser.
"It's hard to stop using, so that increases the feeling of hopelessness, and heroin use causes family problems, which increases isolation," she said. Both of those things increase risk of suicide.
The medical community is responding.
Rust said many doctors are limiting prescriptions of pain killers.
Melinda Roth, CHS advanced practice nurse and program manager for psychiatric services, said because psychotropic and pain meds can dangerously interact, she always checks the Illinois prescription monitoring program website to make sure patients aren't getting more controlled substances than they need.
In addition, CHS prescribes limited supplies (a seven-day prescription rather than 30-day prescription) and partners with a pharmacy that packages single doses, Roth said. Both steps decrease the odds of drug dependency.
"Advocate Medical Group physicians...continue to work very closely with patients and pharmacists to ensure that these medications are prescribed safely and appropriately, in ways that help lessen the risk of dependency," said Chief Medical Officer Dr. Kevin McCune.
In Logan County, a collaborative of health professionals, substance abuse prevention and treatment providers, police and fire chiefs and political leaders is working to coordinate community-wide solutions to the heroin epidemic.
Last week, the Illinois Critical Access Hospital Network, which represents small, rural hospitals, hosted a summit in Springfield called "Opioid Crisis Next Door."
Individuals need to know it's OK to seek help, treatment providers said. "They need to know that this isn't the end of their story," Childress said.
And, treatment works. It may consist of four to seven days of detox to help with withdrawal, 28 days of residential treatment, outpatient treatment for as long as needed and support from a 12-step program, providers said.
A medicine called Vivitrol (Naltrexone) — essentially, a longer-acting form of Naloxone — can help, Rust said.
Family members should be supportive, not judgmental, treatment providers said.
"Recovery is possible," Vaughan said, but it takes work, a support system that understands and is a lifelong process.
"A relapse doesn't mean failure," Godley said. "If at first you don't succeed, quit again."
"I'm glad that there's talk about this," Childress said. "We need to realize that this can happen to anyone."