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.
Her son, then 24, tried treatment at four different facilities. He relapsed repeatedly. Two years ago, Torsch found him dead in his room from a drug overdose — the heroin bag still in his wallet.
Torsch said she was pleased with efforts to curb abuse of painkillers but disheartened at the new drug of choice. "In one way, they're making strides in a better control of one substance. And then it sounds like the balloon has to burst somewhere else," she said.
Some regional law enforcement agencies and drug counselors said they are working to find solutions.
"We've seen a huge transition back to heroin," said Lt. Lee Dunbar, who helps lead the Harford County Task Force, a law enforcement initiative geared largely toward cracking down on the use of illegal drugs and legal drugs for criminal uses.
The task force used federal funds to crack down on the black market for painkillers but now is dealing with heroin cases.
"We've also seen it with our seizures," Dunbar said. "We're starting to get a lot more heroin seizures rather than these pill seizures."
Anne Arundel, Baltimore and Carroll counties have not seen a spike in heroin arrests, spokespeople for the police departments there said. Baltimore City has seen a decline in heroin arrests. Howard County did not provide data on heroin trends.
Some say the trends may not be showing up in statistics yet.
Joseph Ryan, manager of the Harford County Office of Drug Control Policy, said his agency has not recorded an increase in heroin overdose deaths, but he knows from drug counselors that its use is a growing problem. He expects it to get worse.
"That is what the kids are telling us," Ryan said. "They can't find Oxycontin, so they're going to run down to the city and buy heroin because they are going through withdrawal."
Heroin use is increasing in other states as well, Sharfstein said.
A spokesman for the Maryland State Police said heroin seizures have risen along the Interstate 95 corridor. Last year, 1,282 grams of heroin were seized in seven cases. This year, state police have seized 3,101 grams in 19 cases. Those arrested were from Maryland as well as other states.
Gimbel, the drug counselor, who is a former heroin addict, said the pool of prescription drug abusers is very large and includes a wide spectrum of people.
Some, like Dan Torsch, started taking pills for pain and soon were hooked. Some began taking the pills for fun and became addicted.
"Then you had those heroin addicts who switched to Oxycontin because it was pure and it was cheap and you didn't have to go through the violence of the drug dealing," he said.
Toni Torsch joined the support group Grief Recovery After Substance Passing, or GRASP, after her son died. She said the drug abuse problem is only getting worse.
She said she would like to see more of a focus on treatment.
"I know heroin's illegal. I know [addicts] have a choice," she said. "I know all of that stuff. But it's so highly addictive. They may have a choice in the very beginning, but once there's that addiction, even with the pain killers, there's very little control that they have left."
Heroin overdose deaths on the rise
The Morning Sun
Prescription opioid deaths
Source: Department of Health and Mental Hygiene
*Figures are for the first seven months of each year