FALMOUTH — Police Lt. John Kilbride has seen a change in his town’s crime and public health landscape.
“If you asked me a year ago … I would have said we are not dealing a lot with heroin,” Kilbride said Jan. 30.
But after three overdose calls last year, including one death, and a Jan. 12 home invasion and robbery linked to heroin use, Kilbride said his department is now confronting increased use of heroin – just like his counterparts in Portland, South Portland and Bath.
There may not be one specific measurement that proves heroin use is increasing, but data from law enforcement and public health agencies around Portland and the state show a trend that backs up the anecdotal claims.
“It is all very frustrating because people have a small piece of the data. Correlating and coordinating all of that is frustrating. You couldn’t plot it on a graph,” said Caroline Teschke, clinical programs director of the India Street Public Health Center in Portland.
The health center is home to the city’s needle exchange, which uses grants and private support to provide anonymous and confidential services and counseling. It has seen enrollment almost double in two years.
Teschke said 451 people exchanged 140,000 needles in 2012. In 2014, 179,000 needles were exchanged by 801 people.
The needle exchange is used by diabetics who lack means to safely dispose of needles, Teschke said, but she also knows what she hears from the people enrolled.
“I think it is pretty clear heroin use in on the increase,” she said. “We hear everyday, ‘I am sick of this, I want to get out.'”
The needle exchange provides a way to reduce the spread of HIV, hepatitis and other blood-borne pathogens, while recognizing intravenous drug use is occurring.
“We do operate around a principle of harm reduction,” Teschke said. “You try to meet people where they are.”
Addiction to opioids – defined by the National Alliance of Advocates for Buprenorphine Treatment as natural or synthetic opiates including heroin, morphine, codeine and oxycodone – is generally on the rise.
But heroin use is growing more, according Kilbride, Teschke, Maine Drug Enforcement Agency Director Roy McKinney, South Portland Fire Chief Kevin Guimond and Tim Nangle, a spokesman for the Portland Fire Department.
Economics plays a key role, McKinney and Bath Police Detective Andrew Booth said.
Heroin can sell for $40 to $45 a bag in Maine, as opposed to the $1 or more per milligram price for a synthetic opioid like oxycodone. The same amount of heroin sells for less than $10 a bag closer to New York.
“We are having drug organizations, gangs if you will, coming into Maine and seeing it as a lucrative market, McKinney said. “They can make a lot more money with a lot less territorial pressure.”
The number of complaints acted on by MDEA agents across the state, the number of arrests, the quantity of seizures, and the percentage heroin comprises of seized opioids all point to an increase in use and demand, McKinney said.
“In 2010, prescription drugs drove everything. We are seeing a shift where heroin is dominating,” he said.
In 2011, the MDEA investigated 69 heroin-related complaints, McKinney said. Last year, it was 307. Complaints led to the seizure of 1.9 kilograms in 2011. In 2014, the amount increased to 2.5 kg on the strength of 390 arrests. He said 75 percent of the MDEA arrests are related to trafficking.
Booth said he works with MDEA agents when overdoses occur for criminal investigations and to gather data on a problem he believes is spreading.
“Heroin is cheaper and easier to get,” he said.
In the two years he has been a detective, Booth said heroin has increased to 45 percent of the drug calls and investigations he handles. In 2012, police data put heroin at 7 percent of what detectives handled for drug calls and investigations, with oxycodone at 38 percent. In 2014, oxycodone represented 15 percent of the total.
The Maine attorney general’s office and Office of the State Medical Examiner are still compiling 2014 statistics, but data on overdose deaths in Maine since 2011 shows fatal heroin overdoses are increasing.
Of the 156 deaths attributed to drugs in 2011, five were heroin-related, while 42 were linked to methadone and 36 to oxycodone. Of 163 fatal drug overdoses in 2012, 28 were linked to heroin, 32 to methadone and 42 to oxycodone. In 2013, 34 of 176 fatal overdoses were caused by heroin, while 37 were linked to methadone and 32 to oxycodone.
The shift to heroin use is also a result of the reduction of supply in prescription pills caused by crackdowns on “pill mills” in Florida and other states, officials said. Prescribed and sold in storefront clinics, the pills were then often shipped north for illicit resale.
According to Florida Attorney General Pam Bondi, increased regulation on pain clinics in the state has reduced their numbers from 900 in 2010 to 367.
Bondi said federal Drug Enforcement Agency records indicated 98 of the 100 physicians dispensing painkillers nationwide in 2010 worked in Florida. None of the top 100 now work in the Sunshine State.
Locally, overdose calls handled by police and emergency medical technicians in greater Portland area have risen.
In Portland, calls for service for overdoses increased from 273 in 2013 to 332 in 2014, according to data supplied by Police Chief Michael Sauschuck. Not all overdose calls are actual opioid overdoses; some occur when people mix their own prescription drugs, Sauschuck said.
Within those overdose calls are an increase in the use of naloxone hydrochloride, or Narcan, an “opioid antagonist” that almost immediately reverses the respiratory and nervous system shutdowns that occur in an opioid overdose.
Nangle said city emergency responders administered Narcan 107 times in 2014, up from 74 times the year before and 56 times in 2012. Last June alone, he said, Narcan was used 22 times because of a heroin batch cut with fentanyl, another opioid.
In South Portland, Narcan was administered 39 times on 52 documented overdose calls in 2014, Guimond said. In 2013, it was used 15 times, and 20 times in 2012.
Dr. Matthew Sholl, who directs emergency medical services at Maine Medical Center in Portland and the city MEDCU response units, on Jan. 30 said he also believes heroin use has increased, although his impressions are anecdotal.
Sholl established the protocols responders use in administering Narcan, and said basic lifesaving skills can be as critical because the respiratory system shuts down and brain damage may occur within five minutes of an overdose.
The effects of Narcan are almost immediate, and can lead to a complete reversal of an overdose, but with frightening results.
“Even when administered properly, it can cause an acute withdrawal reaction,” Nangle said.
Citing rxlist.com, Nangle said the side effects include body aches, nervousness, diarrhea, stomach pain, fever or chills.
“I don’t believe irritable really describes it adequately,” Nangle said. “Violent, assaultive and irrational may be better terms. The vomiting can cause serious problems in an individual with an altered level of consciousness.”
The effects can be so dramatic that Narcan is titrated to the individual condition of an overdose victim to restore respiratory functions during the ride to an emergency room.
Sholl said emergency-room physicians also titrate Narcan doses to prevent the most sudden reversals and after effects.
Last year, the state Legislature passed a bill sponsored by Rep. Sara Gideon, D-Freeport, allowing private Narcan prescriptions and wider use by emergency personnel.
Sholl said he has seen no conclusive evidence on whether wider availability is effective, but reiterated the importance of knowing other emergency procedures.
“I think the story remains to be told. We honestly don’t know,” he said.
Narcan is not a cure, Guimond added.
“You are not fixed. We are giving them an opportunity and trying to give them a couple of doors to go through,” he said.
Booth said addicts need help as much as dealers need to be imprisoned.
“From my point of view, we would like to see criminal aspect stay the same,” he said, “but increase the availability and effectiveness of treatment programs.”
Supplies at the Portland Needle Exchange that help prevent the spread of blood-borne pathogens from intravenous drug use. Enrollment in the needle exchange increased from 451 people in 2012 to 801 last year.
Louis Cavallaro, South Portland Fire Department deputy chief, with a dose of naloxone hydrochloride, or Narcan, on Jan. 30. Last year, South Portland emergency medical personnel administered Narcan 39 times in 52 overdose calls, up from 15 times in 2013, according to Chief Kevin Guimond.
Narcan can be administered intravenously or through an inhaler, but is used to restore respiratory functions after a heroin overdose.