As efforts to crack down on the abuse of prescription drugs have worked, a new problem has emerged, with addicts who can no longer get their fix by popping pills turning to the old-fashioned street drug heroin, health and law enforcement officials say.
The trend shows up in local arrests, drug seizures and overdose deaths. Drug dealers are finding new markets in the suburbs, where teenagers once got their stash from local drugstores or their parents' medicine cabinets, some experts say.
"The kids who got addicted to prescription pills are flipping to heroin, and, as a result, these kids are dropping like flies," said Mike Gimbel, a longtime drug counselor in Baltimore County who now works at University of Maryland St. Joseph Medical Center.
The number of statewide deaths from heroin overdoses increased 41 percent in the first seven months of this year compared with 2011, the Maryland Department of Health and Mental Hygiene said Friday. There were 205 heroin-related overdose deaths in the first seven months of 2012, compared with 145 during the same period the year before.
Overdose deaths related to prescription opioids like oxycodone, hydrocodone and methadone declined by 15 percent, from 208 to 177 in the same periods. Overall drug overdose deaths rose 6 percent.
A collective effort in recent years by federal, state and local governments, law enforcement agencies and medical communities to control an epidemic of prescription drug abuse has slashed the number of prescriptions being issued for commonly abused pills.
Law enforcement aggressively pursued drug mills and clinics selling drugs illegally. A Maryland law passed in 2011 called for the creation of a monitoring system that will require pharmacies to log filled prescriptions in a database. Doctors and other prescribers will have access to the database, which Health Secretary Joshua M. Sharfstein said will be up and running by the end of 2013.
In the meantime, electronic records made it easier for doctors to see a patient's drug history and deny prescriptions to those who may visit several physicians for access to pills.
The efforts diminished the availability of those drugs on the street, which drove up prices and made heroin a cheaper and more readily available alternative.
Sharfstein said the switch by many users to heroin is troubling, and he wants to encourage health care providers to tell people that treatment is available when they decide not to fill a prescription.
"What we don't want to see is people switch to another fatal drug," Sharfstein said. "We want to see them switch to treatment."
The sudden rise in heroin overdoses follows successful efforts that led to declines in its use from 2007 to 2011, according to the DHMH.
The largest increases in fatal heroin-related overdoses were among those under 44.
"We were at heroin, then we had the prescription drug epidemic, and now we're flipping back to heroin, and believe me, the [drug dealers] are obliging and they're hitting a new market: the suburbs," Gimbel said. "It seems to be spreading all over."
Central Maryland reported a 47 percent increase in heroin overdose deaths, Southern Maryland a 54 percent increase and the Eastern Shore an 80 percent jump during the period the state health department analyzed.
Ocean City officials recently launched a weeks-long investigation called "Operation Smackdown" that resulted in the arrest of more than 20 people on felony drug charges and the confiscation of more than 100 bags of heroin.
This year, Ocean City police have seen an increase of nearly 550 percent in heroin cases, compared with last year.
Toni Torsch of Perry Hall knows personally about one person who went from painkillers to heroin.
She was shocked when she found her middle son, Dan, went from taking painkillers for a shoulder injury to becoming a full-blown heroin addict. The pills were too hard to get, while heroin was cheap and easy to find, Torsch said.
"When he used the word 'heroin,' I felt physically ill," she recalled of her son's telling her he was an addict.