Drug overdoses killed more Baltimoreans than homicide for the first time last year, part of a disturbing trend that has seen overdose deaths in Maryland nearly triple in a decade.
Drug abuse experts blamed the trend on a steady rise in the purity of heroin in recent years as South American suppliers have flooded the market. The powerful narcotic may be catching by surprise inexperienced users or those who have gotten off the drug while in prison, they said yesterday.
"If people leave prison and resume drug use when they get out, their tolerance is down and they're very vulnerable to overdose," said John M. Walsh, a researcher with the Washington policy institute Drug Strategies who has spent the past year studying Baltimore's drug problem.
The state medical examiner's office reported that 324 people died of illegal drug overdose in Baltimore last year, passing the total of 309 homicides. In 1998, there were 290 overdose victims and 313 homicides.
Last year, 515 people died of drug overdoses statewide, a 180 percent increase from 1990. While Baltimore still accounts for most of the deaths, the toll has been rising faster in suburban and rural areas.
Since 1990, overdose deaths in the five counties surrounding Baltimore increased 336 percent, reaching 122 last year.
Heroin - sometimes in combination with cocaine or alcohol - accounts for the overwhelming majority of drug deaths, more than 10 times as many as cocaine alone. And the purity of heroin sold on the street has climbed steadily in the past decade.
"You're seeing the consequences of middle-class America deciding this is a chic drug," said Michael W. Gimbel, director of the Baltimore County bureau of substance abuse.
The purity of heroin in capsules seized on the street in Baltimore in the 1980s was between 5 percent and 10 percent, said Special Agent William R. Hocker of the Drug Enforcement Administration. Last year it averaged about 20 percent, he said.
Heroin seized in large quantities in the city last year - not yet diluted with quinine powder for retail sale - ranged in purity from 60 percent to 95 percent, Hocker said.
"A lot of that's the availability of South American heroin," he said, which is taking market share from traditional supplies originating in Asia.
The higher purity makes it possible to snort the heroin rather than injecting it, which has made it more attractive to young users who fear needles and the AIDS virus, which is often spread by shared needles.
Contrary to what many young users believe, fatal overdoses can occur when the drug is snorted, said Dr. David R. Fowler, deputy chief medical examiner.
"It can be just as dangerous to snort as to inject," said Fowler, who said the huge surface area of the lungs allows the drug to enter the bloodstream very rapidly. "We find heroin overdose deaths with no needle marks."
He said the crucial factor in overwhelming the part of the brain that controls breathing is the rate at which the drug is ingested, not just the quantity.
"Giving yourself a narcotic very rapidly is a very dangerous thing," Fowler said.
If high-grade heroin is luring naive young users, it is also an attraction for hard-core addicts. Far from being scared off by overdose reports, they can sometimes be encouraged to seek the drug's power.
"There's that weird reversal in the drug addict's world," said Gimbel, who himself was a heroin addict 30 years ago. "When there's killer heroin out there, they actually want to get some."
The overdose statistics are the latest confirmation of the tenacity of the drug problem in Baltimore, which officials estimate has about 60,000 addicts.
Despite a significant increase in drug treatment funding in recent years, addicts seeking methadone or residential treatment still face long waits.
Mayor Martin O'Malley has said that drug treatment funding will be his top priority in next year's General Assembly session.
According to the federal Drug Abuse Warning Network, Baltimore last year had the highest rate among U.S. cities of emergency-room visits related to drug abuse.