The heroin epidemic: 'It's going to get worse and worse'

CEDAR RAPIDS — One narcotics law enforcement officer says taking heroin is similar to grabbing a loaded gun and spinning the chamber.

Even worse, he added, heroin use is spreading in Iowa, and its deadly reach is likely to continue to grow.

Heroin overdoses, for example, have surged in Cedar Rapids in the past five years.

In 2009, authorities responded to nine reported heroin-related deaths and non-fatal overdoses, which represented 45 percent of all overdoses in Cedar Rapids.

Through June 5 of this year, there have been 52 reported overdoses in the city, 44 of which were heroin-related. Heroin has accounted for 85 percent of all overdose calls this year.

'It's a serious issue — not just the presence of heroin, but the effects that heroin is having on the users,' Cedar Rapids Police Chief Wayne Jerman said. 'The number of overdoses and the number of overdose deaths is very concerning.'

Cedar Rapids is not alone in facing a growing heroin epidemic. One way to gauge the prevalence of heroin in Iowa and where it is being found is through samples, or exhibits, submitted to the Iowa Division of Criminal Investigation Criminalistics Laboratory. According to statistics provided by the crime lab, 37 of Iowa's 99 counties have submitted suspected heroin to the lab for testing since 2005.

However, three Eastern Iowa counties make up a majority of the cases sent to the DCI lab. Of the 47 exhibits submitted to the lab in the first third of 2015, seven were from Johnson County and eight were from Linn County. Collectively, they account for nearly a third of all heroin cases submitted to the lab this year.

Scott County leads the state with 16 submitted cases through the first four months of the year.

Not only is heroin becoming increasingly common, but authorities warn that it's becoming deadlier, thanks to the presence of a synthetic opioid with 80 times the potency of heroin.

And one Iowa Division of Narcotics Enforcement agent warns that heroin shows no sign of slowing down in Iowa.

'I think it's going to be on the upswing,' DNE special agent-in-charge Dan Stepleton said. 'I think it's going to get worse and worse.'

Metro hubs

Heroin is a highly addictive opioid produced from opium poppy. Usually injected by the user, heroin also can be smoked and is a powerful painkiller. It is similar to fellow opioid morphine, but 10 times as powerful.

The heroin found in Iowa is produced by Mexican cartels and distributed through metropolitan hubs, such as Chicago, which helps to explain why Scott, Linn and Johnson counties in Eastern Iowa see more heroin cases than the more populous Polk County.

'Because you have a predominant heroin source of Chicago and those are the closest three counties to Chicago in Iowa and they're metropolitan counties,' Stepleton explained.

Stepleton said heroin usually is distributed by gang members with Chicago affiliations. Criminal investigations often begin with an overdose death, he explained.

'Unfortunately it's usually already a done deal when we get involved,' said Stepleton, who covers a 24-county swath of Eastern Iowa. 'We are working toward the source of supply and not just waiting for an overdose to happen. We're trying to avert those as much as possible.'

According to a study released by the Centers for Disease Control last month, heroin use is rising across all demographics, with women and 18-to-25-year-olds seeing the biggest increases in recent years. Experts point to the rise of prescription drug abuse, especially among young people.

'What we're seeing is young people — high school and college age — will get addicted to Vicodin, oxycotin,' Stepleton said. 'When they run out of the prescriptions, they'll resort to heroin because it's 10 times the potency of that drug. Unfortunately you're already hooked at that point.

Related story:Change in law makes heroin death convictions more difficult to prosecute

'It doesn't take long to make the switch from oxycotin to heroin, which in essence is going to make you a lifelong addict.'

Heroin is not a high-volume drug — it lags far behind more common illegal substances in Iowa such as marijuana and methamphetamine — and it's highly expensive. One ounce of heroin is a 'huge amount,' Stepleton said, and most dealers work in shipments of 10 to 50 grams.

Heroin is purchased for about $200 to $250 per gram and is usually sold for about $50 for a 10th of a gram.

'It's a very expensive habit,' he said. 'That's why most of your heroin users have to be dealers. You just can't afford to get the drug.'

Because of its expensive and addictive nature, heroin abuse often is associated with property crimes such as thefts and burglaries.

'Addicts will do what they need to do to obtain the next fix,' Jerman said.

Lethal

While there is no definitive ranking in Iowa on the most lethal drugs, heroin probably would be near the top of the list in terms of deaths with respect to the number of actual users, according to one state official.

'It would appear that heroin is more lethal than many other substances,' said Dale Woolery, associate director for the Governor's Office of Drug Control Policy.

Woolery said it appears that a greater proportion of heroin users experience overdoses than users of more common drugs in Iowa, such as methamphetamine.

'There are a lot of Iowans that have a strong appetite for methamphetamine,' he said. 'But it's rare, if it ever occurs ...

that you hear of a methamphetamine-overdose death. I think it does occur, but I'm talking very few.'

Heroin typically is sold at a purity of three percent to five percent, Stepleton said.

'After that, it gets very, very lethal,' he said.

However, it's not an exact science and some dealers might not be as careful about diluting their drugs.

'There's no FDA involved in this,' Stepleton said. 'He might dilute it down to 7 to 8 percent ...

Taking it at 3 percent and taking it at 8 percent is a big freaking difference.'

Heroin is becoming even more lethal with the introduction of a drug called fentanyl. A synthetic opioid painkiller, fentanyl is 80 times as potent as heroin and a single piece of pure fentanyl the size of the grain of salt can kill a fully grown man.

'Now they're lacing heroin with fentanyl,' Stepleton said. 'Now you have two drugs together and one is very much more powerful than the other. If I'm taking the same drug dosage unit and it's laced with fentanyl, now I end up with really severe problems ...

You don't have long for this world.'

Stepleton said fentanyl and fentanyl-laced heroin has hit the East Coast hard in recent years, resulting in 2,500 to 3,500 overdoses in major cities. And it's making its way to Iowa.

Bruce Reeve, administrator for the DCI crime lab, said technicians have been seeing fentanyl in the form of patches prescribed for chronic pain relief for years. But more recently they are seeing heroin laced with fentanyl.

In January, the lab examined one case of heroin mixed with fentanyl. In April, there were three more. In May, half of the labs 10 heroin cases had samples cut with fentanyl.

'I think we're starting to see that a lot more in Iowa,' Reeve said. 'It's a trend that's alarming. Fentanyl is a dangerous drug if it's not handled right.'

Stepleton puts it more bluntly.

'I think it's going to be an extreme problem,' he said. 'I can't stress that enough. There is no FDA in illicit drug distribution. It's a crapshoot on what you're going to be buying and putting in your body. ...

It's like putting a loaded gun in your hand and spinning the chamber every time.'

In July, the Cedar Rapids Police Department announced it had received federal funding that would allow it to hire another officer. Having that additional officer will allow the department to place a seasoned professional with the Eastern Iowa Prevention, Treatment and Prosecution Initiative. The officer will emphasize heroin-prevention efforts while also working on the investigation and prosecution of heroin-related crimes.

'From decades ago, (heroin) seemed to be confined to different areas,' Jerman said. 'Now we see there are no boundaries ...

It's making its way into all segments of society.

'Whether it's lower middle, upper middle or the upper class, that's what we're seeing.'

Change in law makes heroin death convictions more difficult to prosecute

A grieving mother displayed a photo of her son in a casket during a February sentencing of a man who had sold her child heroin, saying it's all she has left to remember him.

Stacy Iberg likely is one of many mothers over the past five years in Eastern Iowa who have either lost a child or had a child overdose on heroin.

Her son, Dustin Legrand, died from a heroin overdose last year after Ramon Freeman, 35, of Chicago, sold to someone who provided the heroin to Legrand. Freeman is now serving 30 years in federal prison.

Federal prosecutors say Freeman is only one of 75 people charged in U.S. District Court in the past five years for distribution of heroin, and 38 of those have been in Linn County. From 2011 to 2015, 14 defendants in the Northern District have been charged in cases involving heroin deaths and six have been charged with bodily injury that resulted from heroin overdoses.

But prosecuting these dealers has become more difficult after a 2014 U.S. Supreme Court decision involving an Iowa case in the Southern District, he said.

That case set a higher standard for prosecutors to meet in distribution cases involving death, Assistant U.S. Attorney Dan Chatham said. There must be sufficient evidence the heroin is what caused the death, according to the law.

Prosecutors previously only had to prove the heroin was a 'contributing cause.' In many of these cases, users may take other drugs along with the heroin.

In an overdose causing bodily injury, Chatham said, there has to be evidence that the user was at high risk to die without medical intervention.

Some cases haven't been able to meet that standard to convict for a heroin death, but Chatham and Patrick Reinert, also an assistant U.S. attorney, said they can argue in sentencing for more time based on other factors, such as previous convictions, purity of heroin or how close the dealer is to the main source.

In the sentencing for Freeman in February, Chatham argued for more prison time based on the purity — in that case, 68 to 73 percent — of heroin he was selling, and Freeman's position in the chain of distribution. Dealers with higher purity levels typically are closer to the main source, he said.

Chatham said the overdoses usually occur because the purity is so much higher than what the user is used to. In the past, the heroin might have been cut with another substance, so the dealers could have more product and make more money.

Chatham said there also are cases in the district where users have overdosed because it's mixed with another drug such as fentanyl, used to treat severe pain and often used after surgery.

There were two defendants indicted in June from Cedar Rapids for distribution of heroin/fentanyl and conspiracy to distribute heroin/fentanyl that resulted in bodily injury.