The Milwaukee Post

By JESSICA MCBRIDE Special to The Post WAUKESHA — A lot's been written about "heroin in the sub- urbs." Many reports are episodic: This year's deaths are increasing, authorities have busted a big ring or another promising young per- son has died. It's left pressing questions: How did hero- in become so prevalent in W a u k e s h a County? And why? Drunken driving and domestic violence once monopolized community concern not that long ago. We're educated. Affluent. We parent our children (well, most do). Heroin conjures up images of 1970s skid rows, not Pewaukee or Muskego. The crisis here happened fast — in less than a decade. "It's a different demographic than other drugs," said District Attorney Brad Schimel. "It's the Eagle Scout. The straight-A stu- dent. The star athlete. These aren't the bad kids." The journey to find answers takes surprising turns, from the University of Wisconsin-Madison to northwestern Mexico. It evokes Fast and Furious, unprecedented marketing by Big Pharma, and university researchers who helped lay the intellectual founda- tion by launching a national pain movement that changed society and may have unwittingly fueled an epidemic. It often starts with pills The mythological poison- breathing serpent Hydra had mul- tiple heads. To properly under- stand this crisis and its evolution, consider it Hydra: same body, two heads — heroin and opioid pills, such as Vicodin, Percocet, the cheaper painkiller methadone, and the godfather of them all, OxyContin. They are chemically similar, derived from the same poppy plant, and produce the same high (heroin was once legal- ly prescribed 100 years ago.) Opioid pills are the gateway drugs floating around our purses like Tylenol. It almost always starts there. "There's a pill problem in Waukesha County," Capt. Frank McElderry, commander of the Metro Drug Unit, said. "It almost always starts with pills. There are more pills out here than heroin. No one starts with heroin. You can't talk about heroin without talking about pills." Schimel concurs: "I don't know anyone who started with heroin." Parents lock liquor cabinets or mark alcohol bottles but "no one is monitoring or counting the pills," he added. At least 80 percent of heroin users started with opioid pills first, national research says. While the government gives Mexican drug cartel leaders dis- tributing heroin most-wanted sta- tus, almost at Osama bin Laden's level, a Johnson & Johnson sub- sidiary grows opium poppies used for chemically similar — and legal — prescription opioid pills. They're grown in Tasmania, off the Australian coast. The website of Johnson & Johnson subsidiary Tasmanian Alkaloids boasts poppy fields as pretty as the one that put Dorothy to sleep in "The Wizard of Oz" (the company makes many house- hold-name products: Tylenol, Visine, Listerine, and Splenda among them). Two cohorts use heroin, says Dr. Frank Kolodny, a leading expert on opioids, which refers to drugs — legal prescription pills and illegal heroin — deriving from the poppy. There's an aging cohort still addicted to heroin from the 1970s in urban areas out east, and, in the last 15 years, a bigger, growing cohort of young suburban and rural users throughout America. Like here. Our growing use of prescrip- tion opioids is the underreported crisis and precursor, he says. "They are essentially heroin pills." Kolodny said the number of heroin users who started with opi- oid pills would be even higher except it still includes aging men addicted in the '70s. He thinks it's 99 percent without them. Legitimate pain relief Despite their nexus to the hero- in problem and their own addic- tive properties, prescription opi- oids clearly have a legitimate pur- pose also, as anyone who has suf- fered pain knows. This, though, creates a vexing dilemma for society — how to bal- ance competing public health con- cerns of people's pain and peo- ple's addiction — and where the line should be drawn when it comes to access. It's a pendulum that has swung back and forth several times in the past 100 years. The widespread legal prescrib- ing of opioids for the broader chronic pain population (estimat- ed at 2 million Wisconsinites) — as opposed to terminal cancer patients — is a relatively new thing, dating only to just before 2000. Now the notion of treating pain has broad support. Gov. Scott Walker recently declared September Pain Awareness Month in Wisconsin, saying, "Chronic pain is the leading cause of lost work days, and costs an estimated $100 billion in lost pro- ductivity every year and results in higher health care costs." A clus- ter of Wisconsin pain groups for illnesses ranging from arthritis to dementia joined in the pain treat- ment advocacy. Chronic pain these days is often treated with an opioid pre- scription. A recent news report said the Drug Enforcement Administration was tightening regulations on hydrocodone and moving it from a Schedule III to Schedule II drug in recognition of addiction risks and misuse (pre- venting refills, creating manufac- turing quotas, and so on). It wasn't always so easy to get opioids for such legitimate but not life-ending pain in Waukesha or the country. Now it is. And that, experts unanimously agree, is the root of the heroin crisis here. People usually start with pills that were legally prescribed for someone else (a parent, grandpar- ent). A spokesman for OxyContin's maker points to a Food and Drug Administration letter that calls chronic pain "a serious and grow- ing public health problem" that "contributes greatly to national rates of morbidity, mortality, and disability; and is rising in preva- lence." But there's obviously a public health cost too from treating pain so broadly. Killer on the rise The epicenter for the epidemic is the Waukesha County Metro Drug Unit, where McElderry has mapped drug overdose deaths. They're spread throughout the county. Medical examiner's spreadsheets show opioids were found in almost 80 percent of drug overdose victims here since 2003 — either heroin or, more likely, pills (hydrocodone came up in 27 of the 385 deaths, heroin in at least 55, and oxycodone in 80). Most ingested multiple drugs. Example: A 53-year-old Brookfield man died this year after ingesting morphine (an opi- oid), Venlafaxine (anxiety drug), Diazepam (anxiety and seizures), and Temazepam (insomnia). But "counting bodies" — as the mother of one victim says — "is the least of it." More people use heroin than die from it, average age 22.1 (the age for pill use is higher). "There is no standard person," said McElderry. "It might be the athlete with the professional fam- ily or the welfare family." Rumors abound — this high school football team uses pills; that school is "Heroin High" — but there's no fixed "hotspot." How bad is it? Beds are full at one of the nation's top four behav- ioral health centers, Rogers Memorial Hospital in Oconomowoc. "Alcohol used to be No. 1, but now alcohol and opioids are pret- ty much tied," said Dr. Michael Miller, who runs the addiction center there. As with other experts, he talks about heroin and legal opioid pills as if they are almost indistinct. Outpacing alco- hol is a tough thing to do in Wisconsin. "Alcohol used to be 5 to 1," said Miller. Crime lab cases, heroin offens- es? Waukesha is near tops statewide. Deaths? Up since 2003, spiking in 2012 — opioid deaths are now higher than traffic fatali- ties. Prosecutions? The DA is get- ting national attention for prose- cuting dealers in overdoses. Most recently, a 17-year-old Oconomowoc High School junior was charged with reckless homi- cide using the Len Bias law for allegedly supplying the drug to 19- year-old Archie Badura (there have been over 26 such prosecu- tions here). A cousin who also used heroin remains in critical condition as of this writing. Pill collections? Federal agents incinerated 50,000 pounds last time, third largest nationwide. More American teenagers now use prescription opioids than marijuana. State opioid treat- ment program attendance is up, hospitalizations are up, needle exchanges are up, using naloxone to stop overdoses is up. "Heroin has been an extremely serious issue for six or seven years now," Mark Manthy, acting director of the Wisconsin High Intensity Drug Trafficking Area, a seven-county effort, said. "Public attention is catching up to reality. It's very alarming." James Bohn, who runs the local DEA office, says heroin top- pled cocaine as the region's top drug threat. Second? Prescription opioids. "One fuels the other," he said. Schimel said the problem is "driving everything else, increas- es in burglaries, retail theft, organized retail theft, identify theft, robberies. It used to be rare to have an armed robbery in Waukesha. Now they're routine." Although county drug over- dose deaths dropped in 2013, drugs that can reverse opioid overdoses are more available. Addicts in drug court tell officials they've overdosed seven times. So many pills are floating around that some- times undercover drug cops run 6 • Milwaukee County Post • September 12, 2014 How a killer drug quickly became an area crisis Photo by Charles Auer/Conley News Service Linda Lenz watches a video document- ing her son's battle with addiction. See HEROIN on Page 7 First in a series

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