Paul H. Coleman has spent more than three decades helping people with substance abuse. But in the past few years, he and his colleagues at Maryhaven, a treatment centre in Columbus, Ohio, have begun to see something unprecedented: a small but persistent number of teenaged patients who are sniffing or injecting heroin.
The young people are a disturbing piece of a larger trend. The centre is currently treating more heroin addicts than at any time in its 60-year history, said Mr. Coleman, Maryhaven's chief executive, a shift he attributes to the abundant supply of the drug and the unintended consequences of a crackdown on prescription painkillers.
"You can buy a dose of heroin for less than a six-pack of beer" in central Ohio, he said.
The recent death of film actor Philip Seymour Hoffman from an apparent heroin overdose in his New York apartment is drawing attention to a growing problem across the U.S. Far from being a drug of the past, the number of heroin users – and the number of people dying from overdoses – is on the rise.
Four people were arrested on Tuesday night in connection with the drugs in Mr. Hoffman's apartment, where law enforcement officers found roughly 50 envelopes of heroin, together with syringes and prescription drugs, according to a report from CNN.
The number of heroin users remains lower than for illicit substances such as cocaine, but experts are particularly concerned by the speed of the increase in recent years. A study by an arm of the U.S. Department of Health and Human Services found that 669,000 people used heroin in 2012, up from 373,000 in 2007.
Last month, Peter Shumlin, the Governor of Vermont, used an annual address to highlight what he called a "full-blown heroin crisis" in his state. Since 2000, the number of people receiving treatment for heroin has more than tripled, he noted, with the greatest increase occurring over the course of 2013. Last year, the number of deaths from heroin overdoses in Vermont doubled from 2012. Mr. Shumlin pleaded for more resources for treatment, law enforcement and prevention.
A particularly dangerous phenomenon has been the emergence of heroin laced with Fentanyl, a powerful painkiller and anesthetic. The combination has been linked to more than 50 deaths in recent months in states from Pennsylvania to Michigan.
For Jim Hall, an epidemiologist in Fort Lauderdale, Fla., the rapid rise in the number of deaths from heroin overdoses recalls the start of the scourge of crack cocaine in the 1980s. Between 2011 and 2012, he said, deaths from heroin nearly doubled in Florida.
"The rapid escalation meets the criteria of an epidemic," said Mr. Hall, who conducts research on substance abuse at Nova Southeastern University. "Tragically it's going to get worse before it gets better."
Last month, he participated in a twice-yearly panel convened by the National Institute for Drug Addiction, an arm of the U.S. government. Seventeen of the 20 cities and states represented on the panel identified higher levels of heroin use as their number-one emerging issue in the preceding six months, said Mr. Hall.
One possible factor driving the resurgence in heroin use is the recent crackdown on the illegal use of prescription narcotics such as OxyContin. Drug manufacturers have made such medicines more difficult to abuse – through tamper-resistant tablets, for instance – while authorities have closed down so-called "pill mills," clinics where doctors liberally prescribed powerful painkillers with questionable justification. And as the illicit supply of such medicines has diminished, their price has increased.
"Kudos to the feds for cracking down on the pill mills, but it's almost like you stamp down on something in one place, it pops up in another," said Stephen Chabot, medical director of Gateway Healthcare, a mental illness and substance abuse treatment centre in Rhode Island. Now, he said, he has encountered "people who I would never expect to put a needle in their arm or to smoke or snort heroin" – accountants, attorneys – who are doing just that.
Heroin and OxyContin are both opioid substances that target the same receptors in the brain, rendering them highly addictive. One recent government study found that 80 per cent of the individuals who reported that they began using heroin in the past year had previously abused prescription pain medications.
Marc Fishman, an assistant professor at Johns Hopkins University and medical director at Maryland Treatment Centers, said that the heroin now available is much purer than the version that prevailed several decades ago, which means users can start by sniffing the drug rather than injecting it. Heroin is also inexpensive, reportedly selling for as low as $6 (U.S.) a dose.
"We try to do a good job restricting people's access to prescription opioids, but we may drive people to heroin, which is cheaper and more potent," said Dr. Fishman. Cases of addiction or overdoses by celebrities can shine a much-needed spotlight on heroin abuse, he added. "It's sad that in between, lots of anonymous people, especially kids, are dying. If this brings attention and puts it on the national conscience, that's good."