Confronting the 'heroin tsunami'

POST FALLS — Crushing news came shortly after Cindy Schaffner heard sirens just a few blocks from her Post Falls home.

The sirens, Schaffner learned, were for her 19-year-old daughter, Cathryn Mason.

Cathryn, who loved the outdoors and was majoring in recreation management at North Idaho College, was in critical condition. She’d overdosed on heroin and alcohol.

Cathryn died two days later after she was taken off of life support. That was in May 2014.

"She was a very driven and focused person," Schaffner said, fighting back tears. "She loved to go on hikes and was full of life. She was celebrating getting good grades for the semester."

Schaffner said it was the first time she was aware of that her daughter had used drugs.

"She had a strong sense of morals and values and she had faith, but, for whatever reason, she decided to compromise those values," Schaffner said. "It was a surprise to all of us because she wasn't a user."

Cathryn was caught on the edge of what officials refer to as the "heroin tsunami," a nationwide opioid abuse epidemic that Kootenai County has not been immune to in recent years.

"We have seen a significant increase in the usage of heroin in our community," Post Falls Police Chief Scot Haug said.

Haug said the rise of heroin usage is due to two reasons. It is not only used as a recreational drug for the intense euphoria it induces, but it is an opioid painkiller that people turn to when they are taken off prescription medications or those medications aren't offering as much relief as desired.

Heroin is synthesized from morphine, a naturally occurring substance extracted from the seed pod of the Asian opium poppy plant. It appears as a "China white" or brown powder or as a sticky black substance as "black tar" heroin.

Heroin can be injected, inhaled by snorting or sniffing, or smoked. All three methods deliver the drug to the brain rapidly, contributing to its health risks and high risk for addiction.

"Some experts believe that heroin is more addictive than meth and more difficult to detox off of," Haug said.

The street value of heroin is about $300 per gram, according to police. It is usually sold by the "point" — or tenth of a gram — for $30.

While Cathryn, who graduated from Post Falls High in 2012, was not on painkillers, her sudden and unexpected death shows how lethal heroin can be, Schaffner said.

"Some do it for years and years, while others may try it once and it kills them," she said. "It's like playing Russian roulette."

Rising numbers

News Friday that multiple law enforcement agencies had busted an alleged heroin ring that included a Coeur d’Alene physician put a local point on the severity of the problem nationally. At least 28,648 people in the U.S. died of causes linked to opioid drugs in 2014, according to the Centers for Disease Control, almost as many as are killed annually in car crashes. The class of drugs includes heroin and prescription painkillers such as oxycodone.

A CDC report released last year revealed the number of U.S. heroin users has grown by nearly 300,000 over a decade.

Haug said heroin has surpassed methamphetamine as the most common drug behind marijuana in the community.

PFPD processed no heroin into its evidence storage in 2010, but it obtained 20 heroin items in 2013, 19 in 2014 and 21 in 2015 (the numbers do not reflect heroin-related medical calls).

Haug said he's aware of several heroin-related deaths across Kootenai County around the time that Cathryn died. Investigations into some of those cases, including Cathryn's death, continue.

Haug said his department receives heart-wrenching calls on almost a weekly basis from families of those using heroin who are desperate for help.

"But many times the users don't want help," he said. "The challenge for us is that we can't knock down doors and force people to get help, but we point them and their families in the right direction when there's opportunities."

Kootenai County Sheriff Ben Wolfinger said the rise in heroin has a ripple effect in the community, from law enforcement to substance abuse councils to the mental health sector.

"It's not just a law enforcement problem; it's a community problem," he said.

Dr. Joseph Abate, medical director at the nonprofit Heritage Health, said he believes one reason heroin has regained momentum is because it's cheaper than some prescription painkillers.

"That's an attraction to people who are using opioids without a doctor's recommendation," Abate said. "But people who have been on opioids with a doctor's recommendation turn to heroin too because they have a problem with tolerance to pain, especially younger people. They may start on low doses of pain medication, then they take more and more to get the same amount of relief. It may not make sense to you or I, but to patients who are trying to get relief … .

"Part of the rise of heroin is that people start on painkillers for legitimate reasons and then it just gets out of control. In the past people received the message that pain could be controlled with the right dosage, but now we've learned the hard way that it does nothing more than make a person worse over the long term rather than better."

Spirit Lake Police Chief Keith Hutcheson said as prescription drugs have become more regulated in response to the rise in addictions, people revert to illegal drugs such as heroin. It's a vicious cycle, he said.

"Instead of buying pills on the street, they're now buying heroin because it's cheaper and they can get a higher high for a longer time," Hutcheson said.

Combating the epidemic

One of the ways Heritage Health is trying to right the ship when no opioid is enough is to educate on "mindfulness-based solutions."

"It's thinking of pain differently, just something you learn to deal with," Abate said. "It's not us saying that pain is all in your head. What we're saying is how you perceive your pain makes a difference in what you search for as the solution."

Part of the program is sharing with others how pain affects your daily life and how you label it.

"A lot of people don't have a chance to tell about how it affects your life," Abate said.

Abate said if the only weapon in one's toolbox to fight pain is opioids, it's not likely you'll find relief in a fashion that will allow you to live a reasonable life. Mindfulness solutions, exercise, physical therapy and acupuncture are other tools people can use to treat pain.

"There are better ways to treat pain rather than assuming the only thing that will make it go away is pain medicine," he said. "If people are willing to look at why the pain is not very well-controlled, we can offer them other options so they are safely and reasonably treated without fear of an unintentional overdose."

Abate said while there are good substance abuse treatment programs available, there aren’t a lot of affordable ones. He said providers also need to be educated on who the highest-risk populations are before prescribing medication.

Abate said there has been a push in recent years for providers to monitor patients more closely and lower the maximum doses of painkillers. He said emergency doctors will now often times refer frequent patients back to their primary care providers for pain medication.

At the national level, President Barack Obama will ask Congress for $1.1 billion in his next budget to combat the opioid abuse epidemic, which has emerged as a 2016 campaign issue. The amount Obama wants to spend over two years is slightly more than the $1 billion he’s requested to expedite cancer treatments.

"Prescription drug abuse and heroin use have taken a heartbreaking toll on too many Americans and their families while straining resources of law enforcement and treatment programs," the White House said in a statement.

Abate said the number of people who seek urgent medical care after using heroin is limited.

"We usually don't see them," he said. "They don't wander into the clinic looking for care. They're more likely to be found by law enforcement."

Lisa Aitken, Kootenai Health spokeswoman, said there also hasn't been an increase in people coming to the hospital's emergency room with heroin-related issues.

"That’s definitely not to say that the use of heroin is not on the rise; they are just not making it to the hospital at this point," she said. "It’s sad to think that there are people not coming to the hospital if they are in need of medical care related to heroin use."

Schaffner said that since her daughter died, young women who have struggled or have been tempted have gravitated toward her for support.

"You need to have open communication with your kids and you've got to know where they are at," she said. "If they think you are overbearing, too bad. It's for their own good."

Schaffner said she still struggles with what caused Cathryn to make a "foolish choice." She said her faith and two other daughters have helped her from "rolling into a ditch" after the tragedy.

"You've got to stay focused on the things you do have," Schaffner said. "You can't stop living when other people love you and need you. I have good memories of Cathryn, and I think about her every day. There's a purpose and reason for things and some day I'll understand."