In one month this year, Vigo County set a dubious record – four overdose deaths from heroin.
From 2001 to 2015, Vigo County averaged 3.5 deaths per year – not per month – caused by poisoning from all opioids. That includes heroin, morphine, codeine, oxycodone, hydrocodone, fentanyl and other opiate pain relievers.
Vigo County isn't alone; the state and the nation have seen a staggering increase in overdoses and overdose deaths.
Recent statistics released by the Indiana State Department of Health show that from 2011 to 2015, Vigo County annually averaged 12.9 non-fatal emergency room visits per year due to opioid overdoses. Local emergency responders have said that number grew in 2016 and is continuing to grow.
Earlier this month, police issued a public warning that toxic batches of heroin laced with, among other things, an elephant tranquilizer (carfentanil) had arrived in the Hoosier state. The mixture, called "Gray Death" for its resemblance to concrete, can cause almost instant death from even momentary exposure.
Hard to understand
For people who have no or little exposure to drug use or addiction of any kind, the opioid epidemic may seem overblown or abstract. For some, perhaps most, it's hard to understand or even imagine why someone would repeatedly put illegal and incredibly dangerous substances in their bodies.
But practically anyone can become addicted and a certain number of people will, experts say.
Dr. James Turner, a local family physician certified in addiction treatment, said many experts compare opioid abuse to alcohol abuse, in that it will grab about 10 percent of the people who use it.
“They feel it gives them energy and makes them more alert, and it helps with with depression and even gets them through it for a while,” said Turner who serves as the medical director of the Richard G. Lugar Center for Rural Health at Union Hospital.
But, since opioids are supposed to have a relaxing effect opposite, the opposite response could be a sign that a given user is subject to addiction.
Another predictor, Turner said, is that many people who develop opioid addictions have an underlying mood disorder which could lead them to self-medicate.
But addicts don't come from a single pool determined solely by genetics income, education or any other demographic.
Christy Crowder, a recovering heroin addict who's spoken to the Tribune-Star, said said her own addiction began 15 years ago with prescribed Vicodin after she was injured in a car crash. At the time, opioid pain relievers were frequently prescribed and easy to obtain.
But when her prescriptions ran out, her budding addiction pushed her to pills bought on the street, and then to heroin, which was easier to find and less expensive than prescription opioids. She lost her nursing license and she lost custody of her three children.
“I really had a great life,” she said. “And I wasn't one of those people you would think would be a heroin addict.”
Looking back, she said she would never have started taking prescription opioid painkillers if she could have foreseen her addiction and the struggles she has had since that long-ago accident.
It wasn't until after she was arrested for burglary and theft – and facing 12 years in prison – that she was able to get her life back on track. She has regained her nursing license and is pursuing a counseling degree at Ivy Tech Community College, she said.
The role of pain
Pain, and the avoidance of it, also plays a huge role in addiction. Turner said narcotics withdrawal generates some of the most intense pain a person can undergo.
Further, he said, one person's pain is not like another's; there's no precise, exact and universally shared method of measuring pain nor is there a common tolerance of pain. What might be bearable pain that one person can suffer through can be overwhelming pain for another.
“Pain is subjective,” Turner said. “You cannot see it. It's often hard to manage something that has no vital signs but is subjective.”
Crowder, who now works as a mentor coordinator at Next Step Foundation recovery center at Sixth and Washington streets, concurs .
“You get to the point where you just have to have it (the drug) not to be sick,” she said.
A person who goes without the opioid for longer than 12 hours feels like they are going to die, she said. They vomit, have serious body aches, and the craving is overwhelming.
“You can suffer through it for a couple of days,” she said, “but 99 percent of the time, you're gonna go back to using it.”
Momentarily fulfilling the addiction and avoiding the pain of withdrawal pushes addicts to find and buy available drugs. At some point, the fear of tainted or unpredictable hybrid drugs simply don't play into decision-making. Some new, stronger drug even begins to sound good.
“As crazy as it seems, when we hear about a 'new heroin,' something that's stronger, that's what you go to looking for.”
Treating addiction, fighting an epidemic
Addiction, doctors and other experts say, is a disease. And like many other diseases it must be treated as one which is chronic, life-long and subject to relapse.
In a hospital setting, Turner said, an addict can be treated with suboxone – which takes away the craving and withdrawal symptoms – and receive counseling.
Crowder said professional treatment works. She also credits Next Step Foundation and her faith in God with helping her through recovery. She is setting up a mentoring program for young mothers with addictions who are coming out of prison.
But rescue, emergency rooms and rehab are front-end treatments for addicts. What is an effective measure for local, state and national authorities to fight the opioid epidemic?
Better education of physicians who are prescribing opioids for pain management is one thing that is needed and is occurring, Turner said.
Joseph R. Guydish, professor of medicine and health policy at the University of California San Francisco, said expansion of opioid treatment using methadone or office-based buprenorphine prescription can help, as can increased regulation of opioid prescriptions using tracking systems.
But the most effective measure, Guydish said, is to expand substance abuse and mental health treatment, and to pay for those services on par with other healthcare services.
Katharine A Neill of the Baker institute of Public Policy at Rice University said increased access to naloxone to prevent overdose deaths is needed, as are clean needles through syringe exchange programs to reduce the transmission of Hepatitis C and HIV.
“Prescription monitoring programs are also an important part of preventing diversion of prescription painkillers,” Neill said, “but heroin is readily available to those who seek it out. When it becomes known that there is a lethal batch of heroin on the streets, authorities should post warnings for drug users to exercise particular caution.”
It is also essential to educate relatives and friends on what to do if they suspect someone has a drug problem, said Hilary Connery, clinical director of the alcohol and drug abuse treatment program at McLean Hospital and assistant professor of psychiatry at Harvard Medical School.
“Understand this is a brain illness and a person is not in a clear mental state to make good decisions,” Connery said. “Seek professional help for the patient. Seek peer support for the patient and for yourself.”
Connery is also a supporter of making the overdose antidote Naloxone available to anyone who requests it.
"Naloxone saves lives,” she said. “It is not treatment though, and patients post-rescue need a lot of treatment and support.
“Think about this,” Connery said. “Nobody would ever just say, “Good luck to ya!” to a person who had a heart attack in the mall and got AED-revived. It just never happens. But it happens all the time post-Naloxone.”