First in a four-part series
Copyright © 2012 Albuquerque Journal
This isn’t Detroit. It isn’t Compton, Calif. We don’t have overcrowded and crumbling inner cities.
But when the Centers for Disease Control last November announced that death rates for prescription drugs had reached epidemic proportions nationally, New Mexico was at the top of the list.
Our death rate from prescription drug overdoses surpassed even our traditionally tops-in-the-nation death rate from heroin overdoses.
“This is the time to bring a sense of urgency to parents, schools, coaches, physicians and pharmacists,” U.S. Attorney Ken Gonzales said in an interview.
“Rio Arriba, Taos, (Bernalillo County’s) South Valley, the problem is ingrained in the lifeblood of the community,” Gonzales said. “Its more than a toehold, more than a foothold.”
And Gonzales said communities like Albuquerque’s Northeast Heights are in danger.
“In communities like the Heights, as devastating as the overdoses have been, it hasn’t taken hold in that community, but we have to act with urgency,” he said. “Or we’re going to lose it if we don’t.”
Why New Mexico?
Is it our border with Mexico? Is it the state’s high rate of poverty and the associated social problems? Is it the criminal justice system?
While they may all play a role, the phrase used over and over again in response to Journal questions over the past eight months was “a perfect storm” that is leaving a trail of death in its path.
It turns out that in addition to all of New Mexico’s social problems, the state’s deadly love affair with drugs is fueled by three factors — price, purity and availability.
Just how cheap and pure was illustrated last year during a quick and dirty federal task force undercover operation that arrested 11 user/dealers in the area around Eldorado High School in Albuquerque’s Northeast Heights.
• Undercover agents bought grams of heroin for $100 — the same price as in 1977.
• The purity of the heroin agents purchased was three to four times the purity level of heroin sold just 10 years ago.
• The heroin was cheaper than prescription opiate painkillers on the street, which average $1 per milligram. That’s $10 for a 10-milligram hydrocodone pill.
Federal drug agents say the purity of the heroin and availability of prescription painkillers allow it to be smoked or snorted.
“Kids think they’re not a heroin addict if they’re not using a needle,” one federal task force agent said.
And those kids can buy heroin or prescription drugs near their high schools, as federal agents proved in last year’s roundup around Eldorado High School — several of those arrested were former students supporting their own addiction by selling to youngsters.
Attorney Joseph Riggs has represented criminal defendants for more than 30 years, including many drug addicts.
“What is shocking today is the frightening availability of heroin and painkillers,” Riggs said. “It is a communitywide problem, no longer confined to specific neighborhoods.”
Dr. George Davis oversees psychiatric services at the state Children, Youth and Families Department’s secure lockups in Albuquerque.
“The opiate overdose, call it suicide, rate is just an indicator of neglect, child abuse and broad social problems,” Davis said. “Abuse by parents using drugs drives our numbers of residents.”
And by any measure, New Mexico’s drug problem is widespread.
Among those measures:
• Teen drug use in New Mexico — heroin, methamphetamine and cocaine — is double and triple the national average, depending on the drug.
• The Department of Health estimates there are 25,000 needle-using addicts in the state.
• Department of Justice statistics show that more than half of the New Mexico inmates in state prisons and local jails are arrested for drug-related crimes.
Highest death rate
In 2008, New Mexico had the highest heroin and prescription-drug overdose death rate in the country.
From 2000 to 2008, overdose deaths from opiates tripled.
Those numbers are not manipulated or estimated. They are counted in bodies on an autopsy table and in toxicology reports.
The conventional wisdom — testimony at the Legislature, interviews with law enforcement, families of victims — can lead the public to believe this epidemic is isolated to young people in their teens or early 20s.
Heroin and prescription drug overdoses do, tragically, kill bright young people.
While their tragedies grab headlines, teenagers abusing drugs are not the cause of New Mexico’s national standing in overdose deaths.
The vast majority of New Mexicans dying of drug overdoses are ages 25 to 64.
Out of 2,200 drug-induced deaths from 2005 to 2009, just over 1,900 were men and women 25 years or older.
The median age of those who died of drug overdoses was 43.7 years.
Breaking the statistics down further shows that heroin addicts tend to die of overdoses in their mid-30s.
Prescription drug overdoses kill more people in their mid-50s.
That indicates to epidemiologists who study the problem that people become addicted to prescription drugs at an older age, probably because of health problems.
Heroin addicts tend to start using the drug at a younger age, in their late teens and early 20s.
The problem of widespread prescription or illegal drug use by teens is a long-term issue leading to the creation of another generation of addicts.
Two drug problems
Prescription opioid painkillers and heroin pose two separate problems for law enforcement.
Heroin traffickers operate criminal organizations handling everything from the cultivation of poppies in Mexico to the sale of heroin to user/dealers throughout the state.
Painkillers are manufactured in the United States legally and distributed legally through a regulated system. Prescription drugs become illegal only when the drugs are diverted out of the system.
“We are, from an enforcement and prosecution viewpoint, designed to deal with drug trafficking organizations,” U.S. Attorney Gonzales said. “Prescription drugs present a different dynamic.”
Keith Brown, assistant special agent in charge of the U.S. Drug Enforcement office in Albuquerque, put it this way: “There is no prescription drug cartel to target.”
But the two drug problems do overlap.
People who become addicted to prescription opiates often find they can no longer get access to the drugs, or their habits have become too expensive. Heroin is often a cheaper and readily obtainable alternative.
“You don’t have to look for heroin in New Mexico; it will find you,” Mike Salinas, a heroin addict trying to get clean, said in a recent interview.
Among factors contributing to heroin overdose deaths:
• Multigenerational heroin addiction is part of the cultural fabric of communities in the Rio Grande Valley.
• Mexican cartels have been marketing cheap, high-quality heroin to younger users in affluent neighborhoods.
• Heroin production in Mexico has been at an all-time high over the past four years.
Federal narcotics agents raid drug dealers, not the family medicine cabinet.
As a society, we’ve been trained to take pills, from daily vitamins to cold tablets.
“We’re a pill-popping culture,” Jennifer Weiss of the Heroin Awareness Committee said.
“Once a kid gets addicted to prescription pills, it is a very short leap to heroin.”
“The development of a prescription drug habit is subtle,” the DEA’s Brown said. “Parents and family members have no idea what to look for.”
Dr. Harris Silver knows just how subtle painkillers can be.
More than 20 years ago, they almost destroyed his career as a medical doctor, and now he spends his time educating other doctors, legislators, parents and anyone who will listen about the dangers of prescription painkillers.
“People don’t realize that one in 20 patients receiving a prescription for opiate painkillers is at high risk for addiction,” Silver said.
“It takes 11 days of daily use for someone to start showing signs of withdrawal if they stop taking the pills,” Silver said. “That’s how quickly addiction can happen.”
Silver was the lead analyst on a legislative drug task force report prepared by The Robert Wood Johnson Foundation Center for Health Policy at the University of New Mexico.
Silver found these contributing factors for prescription drug overdoses in New Mexico:
• Pharmaceutical companies deliberately downplayed the addictive qualities of prescription painkillers in promoting their use for more than a decade, until sued by the Department of Justice. The lawsuits were settled for almost $1 billion.
• State Medical Board rules around the country, including New Mexico, put doctors in a position in which undertreating pain by failing to prescribe pain medication constituted malpractice. As a result, doctors sometimes prescribed more opioid painkillers than necessary.
• Patients, and for teen patients their parents, are unaware or uneducated about the dangers of prescription opioid painkillers.
• Well over half of prescription pain medications used illegally come from family members, according to federal studies.
“We are too casual in the use of pain medication,” Silver said. “There are risks with every patient receiving a prescription, and those risks can be extreme.”
The news isn’t all bad.
At the state and local level, some positive steps have been taken and are showing some results. Among them:
• The number of drug overdose deaths were lower statewide in 2009 and 2010, down from a high of 500 in 2008 to 466 in 2009 and 477 in 2010.
• The State Board of Pharmacy voted in June to increase monitoring of prescription opioid painkiller drugs.
• The State Medical Board is making voluntary guidelines on opioid drug prescriptions mandatory for doctors and others.
• Harm-reduction programs run by the State Department of Health are making more inroads into communities where heroin use has been widespread for decades.
• A U.S. Senate committee is investigating financial ties between the pharmaceutical industry and “pain” lobbyist organizations that push back against regulators’ attempts to rein in the growth in the use of painkilling medications.
• Albuquerque Mayor Richard Berry and mayors around the country have joined in a campaign to educate parents about safeguarding prescription medications.
• Parents of teens who died of drug overdoses or who are fighting addiction have joined together to educate other parents and push for programs and reforms — much like Mothers Against Drunk Driving did decades ago to fight the state’s drunken driving problem.
“I don’t need to talk to a gymnasium full of kids,” the DEA’s Brown said in a recent interview. “I need to talk to gymnasiums full of parents. They’re the ones we need to educate.”
That’s not just a cop talking.
Mike Para works for the YDI Inc. Gang Intervention Program and has the tattooed “cred” and music chops to talk with any teen.
“Parents. Parents. Parents. They’re the ones who have to listen. They’re the ones who can provide the structure these kids need. They’re the ones we need to be talking to.”