Heroin's Hold: Authorities take varied approaches to addressing opiate epidemic

CEDAR RAPIDS — Derek swore he'd never do heroin.

The 24-year-old Cedar Rapids native got hooked on opiates as a teenager after being prescribed prescription painkillers when his wisdom teeth were removed, taking as much as he could get his hands on. But when those pills became harder to find a couple years ago, Derek started snorting heroin.

[naviga:h3 style="font-size: 21px; text-align: left;"]Heroin's hold in Iowa

For the past month, Gazette reporters have been taking an in-depth look at the opioid epidemic in Iowa. The final story in our series focuses on possible solutions to the problem.

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'The pills became impossible to find, almost,' he said. 'Then it was, 'I'll never inject heroin, I'll just snort it.''

But before too long, Derek was shooting up. He got clean for several months in 2015 when he went on methadone, but was using again by late October.

He shot up heroin in a bathroom on Christmas Day.

But everything changed one night in January. Around 7 p.m. on a Friday evening after work, he got pulled over by a Linn County Sheriff's deputy for expired registration. When the deputy found a needle in his car, Derek confessed to carrying two plastic bags of heroin he had stuffed down his pants.

Derek told the deputy how long he had been using, and how he wanted to get help but didn't want to lose his job in the process.

'We got to the jail,' Derek said. 'He stopped outside. He came to my door. He said, 'Derek, I want you to give me everything illegal that you have on you because once you go inside I can't help you. I'm willing to take all of this and seize this property and you're never going to be charged for any of this.'

'I just kind of broke down right there,' he recalled. 'A week later, I put the call in here' to the Cedar Rapids Treatment Center.

'It truly seemed he (Derek) wanted help,' Sheriff Brian Gardner said after speaking with his deputy to confirm the details of Derek's account.

Police, lawyers and other experts who are tackling Eastern Iowa's growing opiate epidemic know arrests alone won't curb the drug's spread.

'You can't prosecute your way out of this problem,' said Steve Young, assistant U.S. Attorney for the Northern District of Iowa.

Instead, authorities say the approach to combating heroin and opiate abuse is like a three-legged stool, with prosecution, treatment and prevention efforts representing the three legs. The goal of the Eastern Iowa Heroin Initiative — a federally funded program — is to 'even out' those three legs by creating public awareness about the heroin problem in Iowa, educating people about opiate abuse and trying to prevent new addicts, all in addition to prosecuting heroin dealers.

The Eastern Iowa Heroin Initiative launched in September 2015, two months after the Cedar Rapids Police Department received funding from the High Intensity Drug Trafficking Area program. The initiative covers Linn, Dubuque, Black Hawk and Johnson counties — four counties hit hard by heroin in recent years.

Local authorities — who provide the personnel for the initiative but no funding — can reapply for funding each year. St. Louis has a similar program, but without a law enforcement component.

"You can't prosecute your way out of this problem."

'The goal of the initiative is to address the supply side and the demand side,' said Patrick Reinert, Assistant U.S. Attorney for the Northern District of Iowa.

To that end, Reinert and Cedar Rapids Police Officer Al Fear, coordinator for the initiative, have undertaken several efforts to address opiate abuse from a number of angles. Fear and Reinert have hosted community town-hall meetings in a number of Eastern Iowa cities, including Cedar Rapids, Dubuque and Clinton, with the goal of raising awareness about opiate abuse.

One message they are trying to get across is that heroin often starts with prescription pills, and that addiction cuts across all demographics.

'Heroin is an equal opportunity offender,' Reinert said.

Reinert said they also are providing training to law enforcement agencies to 'get to the root' of the heroin problem.

'It's not just about identifying heroin and making arrests,' Reinert said of police officers. 'It's about how to treat an overdose as a crime scene ...

Treat it as a crime scene and treat them (the users) as a victim. You can help them think about getting into treatment.'

Getting heroin users into treatment ideally will reduce the demand for heroin, Reinert said.

Fear said one way authorities are hoping to keep new people from becoming addicts is to limit their access to prescription drugs. To that end, drug drop boxes are being installed throughout Eastern Iowa to give people a place to dispose of their unwanted or leftover prescription drugs before they can be abused.

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According to the Drug Enforcement Administration, 10 drug take-back events in the past five years have led to the collection of nearly 60,000 pounds of prescription drugs statewide. Authorities say unsecured drugs left in homes can be abused. Police are finding drugs on school age students, some of which authorities say could be coming from their parents' medicine cabinets.

'Our current goal is to have one box in every county by the end of the year,' Fear said, adding they are only about 25 drug drop boxes shy of that goal. 'We're trying to use the drop boxes to cut off that link from prescription drug abuse to heroin abuse.'

One tool already is in place to reduce the illegal obtaining of prescription drugs through pharmacies. Terry Witkowski, executive officer of the Iowa Board of Pharmacy said the Prescription Monitoring Program was launched in Iowa in March 2009. That program requires pharmacies report to the PMP every time they dispense a Schedule II through IV drug, which includes opiates.

Doctors, pharmacists and other authorized agents then can access the PMP database to see which medications are being prescribed to a patient.

'The essential goal of the program is to provide practitioners with information that will help them to make sound decisions regarding their patient's health care,' Witkowski said.

A benefit of the program is it can help prevent doctor shopping — going from doctor to doctor to obtain several prescriptions for narcotics — by monitoring each time a patient obtains a new prescription. Instances of patients receiving Schedule II, III or IV drugs from five or more prescribers or pharmacies have dropped from 3,293 in 2009 to 355 last year.

'I think the PMP is a valuable tool, simply because it gives the doctor more information about the patient,' Reinert said. 'It can cause the doctor to not prescribe to the patient or to talk about the cycle of abuse.'

There are hiccups in the system, however.

Only pharmacists are mandated to report prescriptions dispensed and neither prescribers nor pharmacists are required to check the database when writing or filling a prescription. That's something Reinert and Fear hope to address by advocating to have the PMP integrated into electronic patient health records.

'Any voluntary system is going to have gaps,' Reinert said. 'The more we can integrate health records into the PMP, the easier it will be and the more compliance you'll have.'

Linn County also could soon be home to the first of its kind program in the state. By late summer or early fall, Officer Fear hopes to provide shots of Vivitrol to those who have been arrested for heroin possession and express a desire to get clean. Vivitrol counteracts the effects of opiates, curbs cravings and also will cause a user to get sick if they use heroin.

A shot of Vivitrol essentially would buy a user 30 days of sobriety, Fear explained.

'It's for that person who has hit rock bottom and is ready for recovery,' he said. 'It's a great start.'

Users will then have a month to line up another medication and get into a treatment program, Reinert said.

There are some drawbacks to Vivitrol, however. A user must avoid opiates for a month before taking the shot, which would require going through withdrawal without the assistance of a drug such as methadone.

'It's like having the worst flu you've ever had ...

for about two weeks straight,' Reinert said.

There's also the cost. While Vivitrol is covered by insurance in Illinois and only costs $5 per shot, it is not covered in Iowa and runs $1,200 to $1,400 a shot.

The Vivitrol representative in Iowa has agreed to make the first shot free for new users. Reinert and Fear hope to get Vivitrol covered by insurance in Iowa by advocating to the legislature as well as private insurance companies, Fear said.

Gardner said new inmates with known drug addictions or who are displaying symptoms of addiction are seen by a nurse when they are booked in the jail. While they are in custody, people involved with Narcotics Anonymous and Alcoholics Anonymous visit the jail once or twice a week. Inmates also are provided contact information for services for after their discharge from jail.

"It's like having the worst flu you've ever had...for about two weeks straight."

'Because we are a county jail and not a prison, the inmates are often in our custody for only a brief period of time,' Gardner said. 'That often does not provide enough time for quality health care to actually treat addiction.'

Recognizing they cannot tackle the opiate problem alone, Reinert and Fear have created CRUSH — Community Resources United to Stop Heroin — a community-based action team that essentially is the grass roots arm of the Eastern Iowa Heroin Initiative. Fear said CRUSH will attend community events to talk about addiction, treatment options and resources for families as well as sponsor golf outings, 5K races, guest speakers and other events

The organization also will host drug summits for school-aged children, Fear said.

Another CRUSH goal is to set up local response teams, including volunteers who will to local hospitals and provide information and support to families struggling with the fallout of opiate addiction.

Chapters have been established in Linn, Black Hawk and Dubuque counties with the goal to have a chapter in every county in Iowa. Fear said anyone can be a member of CRUSH and only need to text the word 'heroin' to 51555 to join.

Meanwhile, Derek reported in late May that he's been straight for three months. He credits his success in his second attempt at rehab to the support from his family. He called that night with the sheriff's deputy a 'golden opportunity' and not one that he's going to waste.

These days, he's working as well as receiving medication and counseling at the Cedar Rapids Treatment Center.

'It was a huge wake-up call,' Derek said. 'I'm worth something. I'm meant for something better than that.'

He added that he hasn't seen that deputy since that night.

'It'd be good to tell him, 'I took your advice,'' he said.

Need help?

— Area Substance Abuse Council residential treatment: (319) 390-4611, asac.us

— Cedar Rapids Comprehensive Treatment Center: (866) 289-0045, cedarrapidsctc.com

— UnityPoint Health-St. Luke's Hospital chemical dependency program: (319) 363-4429, unitypoint.org

— Mercy Cedar Rapids Sedlacek Treatment Center: (319) 398-6476, mercycare.org

— Prelude Behavioral Services: (319) 351-4357, www.preludeiowa.org

***

Editor's Note

In specific instances in this monthlong series on opioid abuse, 'Heroin's Hold,' The Gazette has made an exception to its policy of requiring the inclusion a primary subject's full name in its stories.

In 'You can't prosecute your way out,' Derek had been referred to The Gazette by the Cedar Rapids Treatment Center, where he has been receiving treatment and counseling for several months for heroin addiction. His account of his encounter with a Linn County deputy was verified by Sheriff Brian Gardner, who watched a dash-camera video of the traffic stop and spoke with the deputy. The deputy declined to be interviewed but also verified Derek's account to The Gazette.

Derek has remained employed throughout his struggle with addiction and believes being publicly identified could cost him his current job and therefore the means to support his ongoing treatment.

In 'Breathing in a new life,' Abby — who was the principal subject of the first story in this series that ran June 5 — allowed The Gazette broad access to her life. The newspaper agreed with her request not to publish her last name.