The prescription opiate crisis in the United States kills more than 40 people per day.
Although that figure — which many estimate is now more than 50 — seems distant from a town like Ridgefield, the reality of this devastating situation is that nobody can afford to ignore it anymore. Seventeen overdose incidents occurred in 2012 in Ridgefield.
“The number of overdose deaths from prescription opiates has tripled over the past decade; they now kill more than heroin and cocaine combined,” said Marita Bonanni, who has worked in Danbury Hospital’s Emergency Department since 2000.
“It’s an epidemic that is everywhere, not just in cities or urban areas.”
While prescription drugs have proven they are more deadly than street-level ones, the prescription opiates are merely the first step in an insidiously destructive cycle of drug use and abuse that continues to cripple the nation.
“Prescription drugs is the beginning of the cycle we tend to see that leads to heroin use,” said Detective Brian Durling of the Ridgefield Police Department. “It starts with them for whatever reason — a sports-related injury, a medical procedure or a freak accident — and then they start using them and then abusing them.”
Experts in the field suggest the resurgence of heroin in the country is directly correlated with prescription drug-based addiction that leads opiate addicts to seek a similar high at a cheaper price once their prescription source runs out.
“The supply is very limited,” said Detective Durling. “You get them from a doctor and you get X number of pills. When that runs out, you’re hitting the streets where they range from $20 to $40 a pill, and they are hard to find. Heroin, on the other hand, is easy to find, it’s not regulated in the same way and it’s cheaper.”
How the addiction in the brain occurs isn’t correlated to why someone would start using prescription drugs or heroin, though.
“The user becomes physiologically dependent if he or she uses on a daily basis over a short period of time, and that has nothing to do with why they started taking the drug in the first place,” said Dr. Eric Collins, the physician in chief at Silver Hill Hospital in New Canaan. “For many people, the effect is euphoric and very pleasant when used in concentrated doses to relieve pain.”
Dr. Collins said the way someone ingests the drug may lead to further dependence and therefore abuse.
What begins as swallowing a few pills found in an unused prescription bottle progresses into snorting, smoking or injecting heroin to get a better, more long-term high, he said.
The typical pattern is use, tolerance and then abuse until “the habit escalates with its costs to the point that the user doesn’t have a choice, and that’s when they switch to heroin to maintain the high.”
Former NBA player Chris Herren “said it best when he came to talk in town — ‘I have never seen a heroin user who started with heroin’ — and that’s really true,” said Capt. Tom Comstock of the Ridgefield Police Department. “It always starts somewhere else — usually with smoking pot and then it goes to snorting prescription drugs — and the user works their way up to heroin.”
While medicine cabinets serve as the primary location for teens to access synthetic opiates, harder street-level drugs, such as heroin, are readily available as nearby as Danbury.
“The pathway to illegal drugs has moved from Bridgeport and New Haven to Newtown and Mill Plain Road in Danbury,” said Rudy Ruggles, co-chairman of the Ridgefield Coalition Against Substance Abuse. “Riskier areas have been removed, and that, of course, has made it easier to access certain drugs like heroin. The turnaround time to get them is relatively short.”
Capt. Comstock didn’t specify how close the sale of harder drugs has gotten to Ridgefield, but he said the original chief source has remained constant.
“We are so close to New York City, it’s not that difficult to figure out where it comes from originally, but there are other channels it goes through before it gets here — to cite one source would be ignorant on our part, it could be coming from anywhere,” Capt. Comstock said. “It comes from overseas, across the border. It makes its way to the street dealers, and that’s harder for us to track.”
Ms. Bonanni reaffirmed that New York and Boston are large distribution centers for large quantities of illegal drugs coming into the country from South America and the Middle East, but stressed that prescription drugs are more of a domestic threat.
In particular, she cited “pill mills,” or pain treatment centers, in Florida that found loopholes in the law in the late 1990s and early 2000 and were able to prescribe more than 100,000 pills a month before being shut down.
The history of the industry explains how the addiction has spread so rapidly.
“In the initial discussion of these drugs, dating back all the way to the 1980s, the risk of addiction was underestimated, and that coincided with a radical change in health care behavior, where the tendency became prescribe instead of treat,” said Dr. Collins. “The pharmaceutical companies’ promotion of their product fueled all of this and compounded it to the point where people got physically dependent and were suffering from withdrawal symptoms when they would get off the medication. …
“These medications are supposed to be for the short term, but over a longer period of time the tendency is to abuse them, and that’s when addiction forms.”
National statistics back this up. According to studies conducted by the Drug Enforcement Administration, 3.8-million Americans were abusing prescription drugs in 2000. Ten years later, that number ballooned up to 7 million — more than all other drugs combined.
The Ridgefield cycle
But when did the medicinal use end and the cycle of addiction begin here in town?
It didn’t happen overnight or over the course of a year.
“Over the last five to six years it’s evolved into a problem that affects a much larger group of people, smaller communities like Ridgefield, but it’s been around the medical field,” Ms. Bonanni said. “Drug addiction is nothing new, but the form which it has taken on and who is being exposed to it has changed. …
“It’s been a perfect storm over the last 10 years, where in the medical field we needed to treat pain more adequately, so physicians were encouraged to address pain and prescribe large dosages. And then, outside of our industry, you have a society that is more stressed than it used to be because of the financial crisis and they are looking for pills to alleviate that stress.”
At the local level, officials admit drug abuse has been a problem for more than a decade and the difficulty lies in weaning someone away from a drug they’ve become dependent on.
“Prescription drugs have always been a problem here, but not in the arena you are seeing them today,” First Selectman Rudy Marconi said. “Over the years, people have gotten addicted to the drugs that are on the market and abuse them. When you stay on some of these drugs for so long, you can’t get off them, and that’s what we’re seeing a lot of.
“How do you wean somebody off of an opiate or any highly addictive substance? That’s a huge question the medical community continues to face.”
Detective Durling added that the transition of drugs from prescription medications to heroin has gradually become more of an issue in town recently. That shouldn’t be taken lightly, especially with an increase in the purity of street-level drugs, he said.
“The local pharmacists can’t increase how effective a pill is the same way that a drug dealer can when he puts different substances in the product he’s selling,” Detective Durling said.
In August 2008, a state mandate made firefighters and EMS responders switch to electronic data capturing at the scene of accidents to better track statistics, trends and other important data for the state, fire Chief Heather Burford said. Previously, data collection was recorded by hand.
Chief Burford said the state has not listed drug overdoses as a point of interest in data tracking. She added that “overdose” is too broad a term for the data to capture.
“The data could record it as ‘breathing problems’ and then we see it as unconscious not breathing versus unconscious breathing — not as an overdose,” she explained. “We may not know if it’s drug-related when in the field and when responding, it could be written as a respiratory problem. It’s so hard to pull explicit drug use from one of these categories because we are not asked to delve that deep into it.”
The numbers from 2009 to 2012 indicate that drug overdoses in Ridgefield have been relatively stable — 13 in 2009, 15 in 2010, 14 in 2011, and then the 17 in 2012.
Besides responses to respiratory problems, Chief Burford said incidents involving negative side effects of drug use could be labeled under “psychiatric problems,” “unresponsive,” and “seizure” as well as cardiac arrest and car accidents. She noted these categories have seen a spike in recent years, but couldn’t speculate on whether it was correlated to drug abuse.
While this data process explains why EMS responders and police officers haven’t seen a rise in drug abuse in town, what’s perhaps most alarming is that prescription drugs aren’t on the state’s radar when it comes to EMS reports.
“Prescription drug overdoses aren’t on our list of requirements for EMS documentation,” Chief Burford confirmed. “Our goal is to correct the problem before the data shows it, but we’re not asked to track it on a local, state or national level. We are following trends for stuff the state believes we can prevent and prepare for. …
“The system is not designed to send us a flag in these types of incidents when the number of incidents is higher or lower than usual. We are left to answer the obvious question: Is it an anomaly or is something causing this spike or dip?”
Although there’s no data to pinpoint when exactly the prescription drug addiction boomed in town, Liz Jorgensen, a Ridgefield drug counselor, sent 30 to 40 people to rehab for prescription drug addiction from September 2009 to September 2010.
“It had been building up for years, but that span from the fall of 2009 to 2010, and even into 2011, was particularly horrible,” she said.
She believes the problem can be traced back to 2000, when Purdue Pharma released the chemical patent for OxyContin.
“I had a doctor who worked for Purdue tell me eight or 10 years ago that he wished they could undo the patent for OxyContin,” she said. “I’ll never forget that conversation. …
“What has happened since then is kids have grown more susceptible to availability and accessibility, and they’ve allowed themselves to be influenced more by peers.”
This is the second article in a series about prescription drugs and heroin use, abuse and addiction in Ridgefield. Next week’s will discuss who is being affected and why a person would use drugs non-medically.