October 11, 2016 by and
Photography by Bill Sitzmann
Illustration by Kristen Hoffman

Getting high on injected heroin—or one of the several synthetic equivalents—does not feel like an orgasm or a dozen orgasms. That is a mythical description the average non-user appreciates, so it gets repeated. The truth is more sinister. Whether you spike a vein with melted oxy in a back alley or get your Dilaudid prescribed in-hospital, getting high on injected opiates feels like being 4 years old, falling asleep in your mother’s lap while watching your favorite movie. You feel safe, warm, satisfied, and content to do nothing. Your nervous system melts like butter with a warm tingling sensation. Emotional and physical pain dissipate. Trauma becomes meaningless. You nod off. Occasionally, you approach consciousness long enough to melt into it again. And on it goes over and over. The first time is always the best, and no matter how long you chase that first high, you will never see it again.

According to Nebraska’s Vital Statistics Department, at least 54 people died from overdosing on opiates in the state during 2015.

Anything above and beyond pain relief is experienced as a rush of dopamine to the pleasure center of the brain. Addicts will escalate the amount of opioids they consume until coming across a bad batch mixed with other drugs—such as large-animal tranquilizers—or they stumble onto an unusually pure source, take too much, and overdose. Some users accidentally consume a fatal cocktail of prescriptions with alcohol or other drugs. In recent years, overdoses involving opiates have claimed the lives of several celebrities: the musician Prince, actors Philip Seymour Hoffman, Heath Ledger, Cory Monteith, and the list goes on.

In the state of Nebraska, deaths from opiate overdoses are on the rise. According to Nebraska’s Vital Statistics Department, at least 54 people died from overdosing on opiates in the state during 2015. Nationwide, the U.S. Department of Health and Human Services reported that six out of every 10 drug overdoses involve opiates of some kind. From 1999 to 2014, roughly 165,000 Americans died from opiate-related overdoses, quadrupling the numbers from previous years, according to the Center for Disease Control. The death toll is climbing. The most recent CDC estimates suggest 78 Americans overdose on opiates every day.

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The Local Frontline

Russell Janssen is a case manager at the Open Door Mission, located between Carter Lake and the Missouri River. At age 20, he was introduced to heroin and was an intravenous user until the age of 39. Off heroin now for nearly two decades, Janssen spends his days treating people with the very addiction problems he has faced and continues to battle.

“I’ve been clean for 19 and a half years and I’ll still have ‘using’ dreams,” Janssen says. “They don’t affect me the way they used to. When I first cleaned up, I would wake up in cold sweats. I’d try to go back to sleep and just couldn’t. I still wake up to this day, but now I can lay down and go back to sleep. The thought is always there, though, and never leaves us.”

Heroin addiction is powerful, Janssen says, too powerful for anyone to be completely beyond it, especially if they think they are “too smart to get hooked.” And while most drugs will provide some high with diminishing returns, heroin burns out the brain’s pleasure center and forces users to do more and more in order to “stay even” and barely functional. Serious daily side effects include nausea, abdominal pain, high agitation, muscle cramps and spasms, as well as depression and cravings leading to relapse.

“The problem with heroin is you have to have it just to maintain,” Janssen says. “It’s not just about getting high. I’d go through $150 a day just to maintain for the 12 to 14 hours that I was up. If I wanted to get high I had to go above that amount because you gotta have it.”

And “it,” per Janssen, is never the same twice. Prescription opioids are a known quality, but black market drugs are unregulated and full of pitfalls. Drugs are cut with useless fillers and other substances to increase profits for dealers: “People die because they’re doing so many weird things with it. People died in Cincinnati, Ohio, because they were mixing elephant tranquilizer in with the heroin. And even though heroin addicts know that it’s out there—and they know it’s killing people—they go looking, thinking ‘I’ve got to have it just to maintain,’ so they’re willing to take that chance.”

Janssen says the access to opioids through prescriptions has changed the face of heroin addiction, making it easier and less stigmatic to start, the biggest mistake anyone can make.

“In the `70s, heroin addicts were the lowest of the low. Even other drug users didn’t want anything to do with heroin users. That’s changed a lot today because people get prescribed opiates, and they think that if a doctor prescribes it that it can’t be harmful for them. But that’s a way that people get addicted. We’re gonna see a lot more people out (in West Omaha) getting addicted.”

Chris Eynon is an eight-year recovering meth addict, a graduate of the Miracles Treatment Program at the Siena/Francis House, and, for the last two years, its treatment coordinator. He is seeing an increase in the number of people seeking help for heroin and opioid addiction.

“We are certainly seeing an increase in the amount of applicants wanting recovery here (in Omaha),” says Eynon, who has also witnessed the dire circumstances facing East Coast communities. He spent several weeks during March in Cumberland, Maryland, a town of roughly 20,000 where he was helping a friend to start a prayer service for heroin addicts. “Out on the East Coast, (heroin addiction) is really significant there. Just in the small community of Cumberland, they have been devastated. Last year in their county they experienced 14 deaths due to overdose, and as of this year already they have experienced over 30. Most of them are high school kids, and most of them are heroin overdoses.”

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From Vietnam Vets to Millennials

The current heroin/opioid epidemic is reminiscent of the Vietnam War era when access to plentiful and pure China White heroin combined with the stress of combat, and roughly 15 percent of all enlisted men had fallen into addiction. In 1971, Operation Golden Flow (the unofficial name of widespread military drug testing campaign) was designed by the Department of Defense to “clean up” American GIs before sending them home. While many came home and never used again because the circumstances of their drug use changed drastically, others relapsed at home as black market heroin followed the demand back from Vietnam to the U.S.

A New York Times article from May 1986 reported the number of U.S. addicts at roughly 500,000 (with 200,000 in New York alone). That heroin epidemic began subsiding as popularity for crack cocaine took over the streets. Studies from the Golden Flow era laid the groundwork for much of what we know about opioid addiction in 2016.

With the widespread prevalence of opiate prescriptions, a 2011 study by the Department of Veterans Affairs found that today’s veterans are at an even greater risk than their earlier counterparts for heroin addiction, as the VA was treating chronic pain with prescriptions for opioids “almost exclusively.” The 2011 study reported that veterans are twice as likely to suffer accidentally fatal opioid overdoses than non-veteran civilians. Since the 2012 height of the VA’s opioid prescriptions to veterans, the federal department has made an effort to decrease opiate prescriptions in favor of more comprehensive approaches to pain management.

Over the past 10 years, the CDC has observed that heroin use among 18-25 year olds has more than doubled in the general population. According to the CDC, 90 percent of people who try heroin have tried at least one other drug first, and, an astonishing 45 percent of heroin users were addicted to prescription opioid painkillers such as Vicodin, oxycodone, oxycontin, fentanyl, Dilaudid, and morphine before switching to heroin. In 2014, prescription opioids killed more than 28,000 of the 2,000,000 Americans dependent on them. From 1999 to 2013, the amount of prescription opioids dispensed in the U.S. nearly quadrupled.

With the widespread prevalence of opiate prescriptions, a 2011 study by the Department of Veterans Affairs found that today’s veterans are at an even greater risk than their earlier counterparts for heroin addiction, as the VA was treating chronic pain with prescriptions for opioids “almost exclusively.”

A May 2014 report from the National Institute on Drug Abuse explains: “It is estimated that between 26.4 million and 36 million people abuse opioids worldwide with an estimated 2.1 million people in the United States suffering from substance use disorders related to prescription opioid pain relievers in 2012 and an estimated 467,000 addicted to heroin. The consequences of this abuse have been devastating and are on the rise.”

Across Socioeconomic Divisions

While the Midwest currently sees fewer opiate overdoses than the coasts, that danger is growing across all socioeconomic segments of the population.

Janssen, Eynon, and several recovering addicts who spoke with Omaha Magazine on the condition of anonymity agreed that teens, the affluent, insured and educated are at risk—because when experimenting with opioid pills, youths often hold the false assumption that nothing bad can happen with drugs prescribed by a doctor, even if those pills were obtained without permission.

“They might steal them from a medicine cabinet or have their own prescription at some point,” Eynon says, echoing similar points made by the other counselors that middle-class white people with many relatives, each with several doctors, might find themselves practically surrounded by easily obtained and occasionally leftover prescriptions. “In my opinion, we will see a lot of West Omaha-type addicts. Prescription medication is usually attained through insurance coverage. In order to have insurance, you would need a job, which falls more into the ‘rich kid’ category.”

Sara B. comes from the less affluent segment of recovering addicts. A fast-talking 32-year-old with attention deficit disorder, also a mother of seven, she signed over the rights to her children to her counselor for their protection while she sought help. She is working hard in order to maintain a relationship with her children.

“I started because people around me, family members were doing it,” says Sara, who has been clean now for the better part of a decade. She still has to guard against relapse, maintaining sobriety for her children as well as her health. She is wary of family who are still actively using. “Which is hard because you have to stay away from users when you get clean if you want to stay clean,” she says. “It’s too easy to fall back.”

Justin Schwope is a 26-year-old recovering addict with four years of sobriety under Russell Janssen’s wing at Open Door. His habit of choice was a speedball, heroin and meth, though other stimulants can be substituted.

“I’d been messing with drugs since I was 16 and my grandparents died,” Schwope says. “I wasn’t able to get clean until I tried kill myself with Lipitor and woke up in Creighton three days later and then transferred to Lasting Hope.”

All sources interviewed by Omaha Magazine agreed that the transition from pure opiates to street junk is the greatest threat to the health and welfare of addicts. When the easy access to opiates runs out, addicts look elsewhere risking everything just to stay even, and even to get that high.

“In Maryland apparently, there was a mass supply of prescription drugs or ‘pill farms’ that were seized and, as a result, (users) turned to heroin, which is cheaper and easily available,” Eynon says. “They have an addiction to feed and, unfortunately, the heroin is not like prescription drugs which are regulated…and the pills are always consistent in strength and dose amounts. When they switch to heroin, they have no idea of the potency or what it might be laced with.”

Increased Regulatory Oversight

Tragic stories of opiate overdoses and abuse have become too commonplace.

After Omaha resident Carrie Howard suffered a severe car accident, she began taking prescription painkillers. The pills led to an addiction that culminated in a fatal overdose in 2009. The legacy of her untimely death made waves through Nebraska’s legislature. Carrie’s mother is former senator Gwen Howard; her sister is Sen. Sara Howard of Omaha.

The elder Howard championed legislation that created a prescription painkiller monitoring program in 2011. But the program fell short in many respects. Sara Howard continued the family’s fight for improved regulatory oversight of prescribed opiates when she introduced LB 471 to the state’s unicameral.

Upon receiving first-round approval in January 2016, several senators recounted their own families’ close encounters with opiate addiction. Sen. Brett Lindstrom of Omaha revealed that one of his own relatives had suffered from a prescription painkiller addiction, an addiction sustained by shopping around different doctors and pharmacies. When the prescriptions dried up, Lindstrom’s relative turned to heroin.

The unicameral finally approved LB 471 in February 2016. It comes into effect in the new year. LB 471 will require pharmacies to report when prescriptions are filled, and would allow pharmacists to check records of past prescriptions to avoid abuse. There are two phases to this. Beginning January 1, 2017, all prescriptions of controlled substances will be reported to the prescription drug monitoring program. Beginning January 2018, all prescriptions will be reported.

A few weeks prior to Nebraska approving LB 471, President Barack Obama had announced that $1.1 billion would be made available for expanded opiate-related treatment opportunities across the country. According to a statement from the White House, “More Americans now die every year from drug overdoses than they do in motor vehicle crashes.”

Already in the previous year, Nebraska received two significant grants to combat statewide opioid-related abuse: one for more than $3 million over four years from the CDC for prescription drug overdose prevention, the other for $500,000 over two years from the Department of Justice.

The funding comes at a pivotal moment. America is experiencing a perfect storm for an opioid epidemic. War, health care in crisis, addiction, easy access, and low employment are among the many factors forcing opioids into the drug user’s spotlight. Once, only the lowest drug users shot junk. Today, if not tomorrow, someone you love might be the next junkie you meet.

To get help for substance abuse problems, call: 1-800-662-HELP.

Additional reporting contributed by Doug Meigs.

For more information about the epidemic, as told by a recovering addict from suburban West Omaha, read: http://omahamagazine.com/2016/10/my-battle-with-opiates/ 

Russell Janssen, case manager at Open Door Mission.

Russell Janssen, case manager at Open Door Mission.

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