Oxy Crackdown Brings Heroin Back

By Myles B. Schlam, J.D., CAP/CCJAP

Oxy Crackdown

Law enforcement has made dynamic efforts to shut down the pill mills that have plagued our South Florida communities for the last several years. As I had predicted when we first started the crackdown, there are signs that heroin is returning as a cheap alternative to prescription pills. While shutting down the pill mills was necessary and certainly a positive thing, it was not the panacea by any means. Addicts will continue to substitute one drug for another that is more easily available and obtainable.

Working in the Broward County Drug Court on a daily basis, I have definitely seen an increase in Heroin arrests recently. Heroin is inching back in Florida, the unintended consequence of the state’s epic war on prescription pills. Now, with Florida officials unsuccessfully slowing the supplies, shutting down the pill mills that masqueraded as pain centers and arresting thousands of addicts and even doctors, heroin has become a popular substitute.

From July 2010 to June 2011, there were 45 heroin-related deaths statewide, according to the Florida Medical Examiners Commission. That number jumped to 77 heroin-related deaths from July 2011 to June 2012. The FDLE also reports a slight increase in heroin-related charges: In the first three months of 2013, heroin-related charges totaled 948. In the same three-month period last year, that number was 772. Broward County addiction treatment centers saw an 87 percent spike in admissions among addicts using heroin as their drug of choice — to 316 from 169 the year before, according to state Department of Children and Family statistics. Palm Beach and Miami-Dade counties also experienced heroin treatment increases, though at smaller levels. Palm Beach County, for example, saw its heroin treatment admissions climb from 170 in 2011 to 198 in 2012, a 16.5 percent increase. (Reported by DCF)

At the height of the prescription pill abuse epidemic about 3 years ago, seven people a day were dying of prescription drug over-doses in Florida. Addicts were lining up outside of pain clinics waiting to get prescriptions, some homegrown and others drug tourists who had traveled to Florida from as far away as Kentucky and West Virginia, Tennessee and Ohio. I would counsel many of these people who got arrested for possession and were now enrolled in our Florida Drug Courts.

I have heard many similar stories of how people come to start using heroin. One common story is that there was an injury and the person started taking prescription pills which they then started abusing. They began to either snort, smoke or inject the pills. Once they are injecting, it is not much of a jump for them to switch to heroin – especially if it is cheaper and more readily available. Faced with a public health crisis, lawmakers attacked the problem with rigorous anti-pill mill legislation that drastically limited who could dispense narcotics and broadened penalties for pill mill operators. They also established a statewide prescription drug monitoring system that kept pill poppers from doctor shopping. By the summer of 2011 thousands of arrests and millions in cash was confiscated. The supply of pills dwindled. The eventual void in the streets- without much focus on treatment and recovery- led those addicted to look else-where for their high. Enter heroin, a drug that cost, on average, as little as a tenth or a quarter of the price of some prescription pills. The price for 30 milligrams of oxycodone jumped from about $10 to roughly $30 last year.

There are now several FDA-approved medications available in the U.S. to treat opioid dependence. Methadone has been available to treat opiate dependence since the early 1970s. Buprenorphine (Subutex and Suboxone) has been available since 2003. Oral naltrexone, an opioid antagonist, has been available since 1984 and the recently-approved Vivitrol, a long-acting, injectable form of naltrexone, is now available. These medications are however infrequently provided to opioid dependent adults in U.S. jails and prisons and in the community under parole or probation supervision. Although behavioral and pharmacologic treatments can be extremely useful when employed alone, science has taught us that integrating both types of treatments will ultimately be the most effective approach. There are many effective behavioral treatments available for heroin addiction. These can include residential and outpatient approaches. An important task is to match the best treatment approach to meet the particular needs of the patient.

In sum, while the state of Florida took dramatic action to reduce the supply of diverted prescription medications, until we provide adequate treatment resources for individuals to end their addiction, the drug may change but the problem won’t stop. The supply may have gone away – but the demand has not. The heroin traffickers you can bet are now seeing a lucrative opportunity. While law enforcement officers and drug control experts are seeing similar spikes in heroin use in communities across the country, South Florida is particularly ripe for the trend, given its proximity to a variety of drug smuggling routes by land and sea -and competition has gotten stiff on the local heroin market. In the past two years law enforcement reports that Mexican drug dealers have moved in on Colombian cartels’ turf, supplying South Florida with a rather pure strain of heroin.

It is important that we remember that Addiction is a disease. We can wipe out this drug or that drug, but addicts will always find new ways to find what they need to get their next high. Limiting the supply alone is not the answer. It is imperative that we continue to fight the overall drug problem with education, prevention and treatment programs which take aim at the root of addiction. Community groups are working to spread the word about the risks of heroin, including dirty needles that can spread disease.

Advocacy groups are also trying to help addicts through legislation. A new law has also been passed aimed at encouraging fellow drug users to call authorities when they witness an overdose. The 911 Good Samaritan Act, which went into effect in Florida last year, protects callers from prosecution for possession of lowlevel controlled substances under some circumstances. Heroin addiction usually requires detox followed by long-term residential treatment. It is unfortunate that we do not have many options in south Florida for such long-term residential treatment that are affordable. Even those with good health insurance will not be covered for more than 60 days of treatment – if they are lucky. These measures are all well intended and good progress has been made. However, in order to truly put a dent in Addiction, officials statewide are going to have to get as serious about treatment as they are about enforcement.

The drugs are only but a symptom of the underlying causes and conditions which cause a person to seek out these substances. Focusing on these underlying factors is what we do at Advocare Solutions, Inc and what we encourage from community providers. The other methods are just like putting a band-aid on a deep, gushing wound which requires surgery. People decide to take drugs for three reasons. They may experience trauma or a stressful episode that leads them to need some sort of escape. They may fall prey to peer pressure, or they may have a mental health problem and are self-medicating. For example, if a person experiences depression, they may look to drugs as a way to feel better. At ASI, we have a long and successful track record of guiding clients who are charged with heroin and other drug charges through the criminal justice system. For a free and confidential consultation please call us today. Drug Evaluations are also provided by appointment only.

*Myles B. Schlam is a nationally recognized expert in Drug Addiction and the Criminal Justice System and an Internationally Certified Alcohol and Drug Counselor (ICADC). He is one of approximately 100 Criminal Justice Addiction Professionals (CCJAP) in the State of Florida. Mr. Schlam graduated from the St. Thomas University School of Law in ‘02 where he specialized in criminal law and interned with the Public Defender’s Office. ASI is licensed by the Florida Department of Children and Families and operates in the tri-county area of south Florida.