Heroin’s spread in Michigan concerns health advocates

By CAITLIN McARTHUR
LANSING — Heroin and related drugs are spreading across Michigan and have become more deadly in recent years, some experts say.
Michigan-wide numbers of unintentional overdose deaths have quadrupled since 1999, according to a Department of Community Health (DCH) report. Meanwhile, the number of deaths due to other drugs such as cocaine has gone down, according the report.
Genesee, Macomb and Wayne Counties account for the highest recent heroin and opioid-related death rates, according to the DCH. But the problem is creeping into other areas: DCH data shows Antrim, Manistee, Clare, Hillsdale and Cass counties all recorded opioid-related overdose rates higher than the state average between 2009 and 2012.

A big reason for the increase in heroin overdoses is the overprescription of pharmaceutical opioids — painkillers like oxycodone, morphine and methadone that are chemically similar to heroin, said Pamela Lynch, consultant and therapist at Northern Lakes Community Mental Health in Traverse City.
The state has recently cracked down on “doctor shopping,” or visiting multiple doctors to get more prescriptions. This means hooked patients have to find another way to support their addictions.
“These drugs are very addictive,” Lynch said. “People get addicted to these pills and when they can’t get the pills from the doctor anymore, they switch to heroin.”
The spread of heroin and opioid use across Michigan will be the focus of a public forum next month, with addiction advocates and health professionals saying the increase in use is exposing problems in the state’s approach to addiction like never before.
The discussion, “Silence Equals Death,” is the brainchild of Lauren Rousseau, a professor at Western Michigan University Cooley Law School, who said the event aims to raise community awareness of the drugs’ spread and effects.
For Rousseau, the rise in overdoses and deaths linked to heroin use hits close to home.
“A young man whom I was legal guardian of became addicted to this drug several years ago,” Rousseau said. “I battled this disease with him, and sometimes against him, for over a year, and ultimately he died.”
Rousseau said her ward was just 19 at the time of his death. His passing — and his struggle beforehand — broke her heart.
“He was like a son to me,” she said. “There are so many people in his position, and who have been in mine.”
The higher mortality rates, Lynch said, was a direct result of heroin’s progression out into the counties. In 2006, she said, heroin-related deaths centered in Detroit, Chicago, South Jersey and Philadelphia — big cities.
But the problem isn’t just in the Detroit area anymore, said Cynthia Arfken, a professor in the Department of Psychiatry and Behavioral Neuroscience at Wayne State University.
Death rates across the state, Arfken said, have increased dramatically, as have admissions to emergency departments.
“Cheap heroin has contributed to the spread,” she said. “When I talk to users, they say they go into Detroit to get the best heroin, because when it is taken out to the counties it is cut.”
The problem with opioids, as compared to other drugs, is that users’ tolerance continues to rise, prompting them to seek more and more of the narcotic.
“Opioid addiction leads to death,” Lynch said. “Other types of addiction do, but not as much as opioids, and not as much as heroin.”
In October the federal Drug Enforcement Administration changed the designation of opioid medication to a schedule II drug, which makes it harder for doctors to prescribe and patients to get.
“Ironically, putting a lid on that problem is now actually driving people to heroin,” Lynch said.
Lynch said Michigan’s response to addiction was improving, though she added it still had a long way to go.
“Addiction has been with us for a long time, and for a long time it has been improperly viewed as a moral issue rather than a health issue,” Lynch said. “This has resulted in pain and misery for countless addicts and their families.”
The state, she said, needs to stop treating addiction with a corrections mindset.
Lynch said one way for the state to address the heroin and opioid problem would be to broaden the availability of a drug known to reverse opioid overdoses: naloxone, also known by its brand name, Narcan.
There have been moves in counties across the state to add naloxone to the kits of emergency first responders. Lynch said this needed to be widened to the state as a whole and expanded to include police, who often beat medical staff to the scene.
A 2014 state law allows families of known addicts in the state access to naloxone, but Lynch argues this is not enough.
Michigan should also have good samaritan laws that provide immunity to people in a drug-use situation who seek help for someone who has overdosed, which could increase the number of 911 calls, Lynch said.
The practice of co-prescription, which would allow naloxone to be prescribed along with any opioid medication, is another step the state could take, Lynch said.
Jennifer Smith, public information officer for the Department of Community Health, said the department had already taken steps to improve its approach to addiction.
The governor recently tasked the department to work with Michigan State Police on identifying risk factors for addiction and addressing them early, Smith said.
“We’ve got a lot of good things going in terms of diversion programs, the health and wellness commission has come out with recommendations,” Smith said. “We are focused on looking at the entire picture and identifying what the real issue is.”