March 14, 2016
Six years ago, Sarah had a simple wish. Every time she stuck the needle in her arm and felt the heroin rush through her bloodstream, she hoped it would kill her.
“I prayed to die every time I used,” said the Milwaukee college student, now 26. “It wasn’t killing me and I was getting pissed.”
Moving between her separated parents on a weekly basis, she had an unstable home life when she was growing up. Sarah (not her real name) felt trapped, with an abusive family in a small Wisconsin town. The Vicodin she stole from her grandparents at age 12 was her first coping mechanism. At first, drugs were an opportunity to escape from her situation. As her addiction grew, she moved from pills to heroin, which she hoped would help her to escape life itself.
Over the years, Sarah attempted rehab multiple times with no success. Then, the day after her 20th birthday, she prayed to God for help overcoming addiction because she knew she could not do it alone.
Sarah did get sober and, in the six years since, the fading scars on her arms from injecting heroin serve as a reminder of a past life. She doesn’t look the part of a former addict; her bright eyes and soft smile hide her true story.
“It’s an internal struggle. I feel like I live two different lives,” she said. “With heroin addiction, you either get sober or you overdose and die.”
While Sarah emerged from the darkness of heroin addiction, others have fallen in deeper. Milwaukee is one of many cities nationwide where heroin use is increasing. The number of people dependent on or abusing the drug swelled by 174 percent across the country between 2002 and 2013, from 189,000 to 517,000, according to the Department of Health and Human Services.
In Milwaukee County, the number of overdose deaths more than tripled, from 34 in 2010 to 116 in 2014. During the past two years, heroin-related deaths have accounted for more than 40 percent of drug overdose deaths, according to data from the Milwaukee County Medical Examiner’s Office. In 2015, 43 percent of the 244 drug overdose deaths through November were due to heroin. The number of drug-related deaths is on pace to eclipse any year dating back to 2002.
In 2014, there were more deaths in the county from heroin overdose than motor vehicle fatalities and homicides combined, according to data obtained from Michael Murphy, Common Council president and District 10 alderman.
Drug death reports from Milwaukee County reveal that more than 65 percent of those killed by heroin between 2012 and 2015 were white. While heroin abuse affects people throughout the county, users tend to purchase the drug in Milwaukee.
In the wake of the destroyed lives, scarred families and high cost to taxpayers, Milwaukee-area leaders are grappling with the best way to deal with the surge in heroin use. There is no single cause, nor is there a single solution to treating it, experts say.
Heroin addiction plagues Milwaukee and the nation. Understanding the cause requires understanding the victims.
Sarah thought everyone in her hometown of Mukwonago, Wisconsin, was judging her family’s poverty. Sarah knew people noticed when her family shoved pink Styrofoam around the windows in the winter because they struggled to pay the heating bill.
Sarah’s mother suffers from bipolar disorder, and Sarah never knew what to expect when she came home. One day, her mother was sprawled across the kitchen table getting a tattoo; another time, she was slicing the wall with a chainsaw. The alcoholics her mother dated abused Sarah. “The cops were at our house four nights a week,” she said.
Abusing prescription drugs was Sarah’s form of rebellion, both an escape and a pleasure. The years of pain and feelings of entrapment finally boiled over one day at age 15 when she hit her mother. Shocked, Sarah’s mother claimed abuse and gave up custody of Sarah.
Sarah then moved in with her father, transitioning from Mukwonago, a town of about 7,500 people, to near Milwaukee, a city 80 times larger. On her second day in the city, Sarah got into an argument with her father and burst out of the house, later getting lost along Greenfield Avenue. She met “David” on her walk. The 21-year-old man was a drug dealer and a prescription drug and heroin user who would later become her boyfriend. When he took large doses of OxyContin, so did she. When he began shooting up heroin, she did the same.
Sarah bought and used heroin on the South Side, near where she lived and went to school at West Allis Central High School. Some days she skipped class; other days she was kicked out. Either way, most days she could be found shooting up in a friend’s house across the street. At night she would go to her boyfriend’s house to continue using. It was not uncommon for her to shoot up and pass out in gas station bathrooms. She graduated high school addicted to heroin.
Sarah lied to her grandparents to get money they believed she was using for rehab. She also stole empty kegs from the restaurant where she worked to get scrap metal money. Nothing would stop her from getting a fix, not even when a heroin overdose killed a friend who was 15. Everyone in their group knew the dangers of overdosing, she said, but they could not stop. Everything, even her friend’s death, was a reason to get high. She thought he would have wanted her to keep using.
Treatments did not work. For two years, doctors gave her Suboxone, a prescription painkiller often prescribed for addicts as an opiate substitute, but she sold it on the street to buy more heroin. “The problem for me wasn’t the drugs, the problem was in me,” she said. “The drugs were an outgrowth.”
The last time Sarah attended rehab, she was part of a group of 12. Workers at the detox center told them that, statistically, only one of the 12 would stay sober. “I don’t have many people in my life from my old life,” Sarah acknowledged. Other users ended up in jail, moved away or died. She has attended many funerals. Years of hearing bad news about those close to her make her voice sound void of emotion. “My friends die a lot.”
One way Sarah has coped is by being an advocate for other former users. “It’s the only way that makes any of it worth it,” she said.
“It’s an internal struggle. I feel like I live two different lives. … With heroin addiction, you either get sober or you overdose and die.”
Scrawled across her wrist in black ink, the word “free” serves as a daily reminder to Robyn Ellis of the addiction that tore her family apart and the sobriety that brought it back together.
The tattoo marked a year of sobriety from drugs for Ellis, a 26-year-old Milwaukee mother. The former heroin user is now approaching three years of sobriety, after a lifestyle that killed her mother and took her daughter away for 14 months.
Ellis grew up in Greenfield, a suburb about 10 miles from Milwaukee. Her school, neighborhood and friends were stable, but her family was not. “Both of my parents were addicts and alcoholics,” Ellis said. Her parents were divorced when she was 5 and Ellis stayed with her mother. Ellis faced the stress of an alcoholic mother alone when her sister moved out to live with their father.
“I remember being very young and always worrying about if my mom was going to come home and if she was going to be safe,” she said. Ellis was 12 when she was diagnosed with scoliosis, a potentially debilitating spine disorder. Going through back surgery and wearing a brace set her apart from other students at school. She began hanging out with kids who frequently skipped class to smoke weed.
She started drinking when she was 12. Within three years, Ellis was smoking weed, using prescription drugs and snorting cocaine. Her sister, who is four years older, and her friends introduced her to new drugs and her mother either accepted the habit or was too caught up in her own addiction to notice. “My mom and I … talked about problems, but we never talked about our feelings, so I was young and growing up and confused and never taught how to deal with how I felt about things. So, it was an escape.”
Three months before graduating high school, Ellis learned that she was pregnant. Three weeks after she gave birth to her daughter, Ellis’ mother died. The death shocked Ellis and made her realize the effects of her lifestyle. “Right when my mom passed away, I went straight to drugs. And that’s when it clicked that this is my main coping skill. Instead of going to somebody and talking to somebody, I’m going to the drugs.”
Ellis was working at the Greenfield Public Library and attending school at Milwaukee Area Technical College at this point, along with raising her daughter. “Normal people have the priority of your kid, your finances and your work, and that’s where it balances on the scale. For me, above all that, was using and staying high.”
“When my sister would look at me like I was selfish because I wasn’t doing what she thought was right for my kid, it was out of my control at that point. It wasn’t like I was purposely being selfish, it was … my addiction taking over.”
Ellis tried treatment, but when that did not work, her sister called Child Protective Services, which took Ellis’ daughter away on Jan. 7, 2013. “I needed that wakeup call,” Ellis said. “It’s probably the best thing that could’ve happened to me.”
She was able to see her daughter during supervised visits, but CPS told Ellis that she would need to receive treatment to get her daughter back. Ellis went to United Community Center’s inpatient program and began a methadone maintenance program. Within a week of leaving inpatient treatment, she relapsed.
After her relapse, Ellis’ addiction was back to the levels she experienced before receiving treatment. “I really just spiraled out of control,” she said. “One day I just realized this isn’t going to get any better unless I do something about it. My kid is not going to come home unless I do something about it.”
Ellis was admitted to Meta House in July 2013. A holistic treatment center at 2625 N. Weil St., Meta House focuses on ending addiction for women and helping them reconnect with their families. The all-female care facility taught Ellis to respect female authority. The program completely changed the way she lived.
Learning to do chores and take responsibility was tough for Ellis. “It wasn’t learning how to live again for me, it was learning how to live for the first time.”
Women can receive inpatient treatment at Meta House as long as they need it, unlike other treatment centers that have a time limit. The residential and transitional housing programs reward women if they fulfill their responsibilities and follow the rules. Providing structure allows them to stabilize and focus on recovering.
The treatment facility also offers health care services, job coaching and parenting classes, said Christine Ullstrup, vice president of clinical services at Meta House. “We are treating all components of the woman and her family.”
Ellis moved out of Meta House’s residential program to the organization’s transitional housing facility in January 2014. She visited Meta House several days a week for outpatient treatment and for help looking for a job. The other days she volunteered, which Ellis said gave her the experience to get her current job at Hope House of Milwaukee, a homeless shelter at 209 W. Orchard St.
Two months after moving out of inpatient treatment, Ellis got her daughter back. Her inexperience as a parent and the lack of role models from her own childhood made the first months difficult. “I beat myself up for a while and I went through a lot of tiring nights of crying and thinking I’m not worthy enough to be a parent,” Ellis said. “Thankfully, I really got blessed with a very understanding and patient child. I have to remember that she’s gone through this journey with me.”
Her daughter, now 7, remembers living with a mother addicted to heroin. Ellis makes sure her daughter has the space to talk about her feelings and have the difficult conversations Ellis never had with her mother.
Ellis credits her family for helping her overcome addiction and stay sober. “We talk about everything. Just being open and honest. If I encounter something, I share my experience and I think that makes it a little bit easier to re-enter society.”
Finding healthy ways to deal with her emotions has been a challenge. Before, she turned to drugs. “You’re numb for so long. Then, when you become sober, it’s learning how to feel. I still struggle with that.”
Ellis shares her story with those she works with at Hope House. She tells people that they need to be willing to put in the work to overcome addiction. “If you’re willing to put in that work, you’re going to see the results.
“I think that sometimes people in addiction don’t realize that, right now, even if you are using, you have this moment. You’re still alive. You’re still breathing and you never know what the next moment can bring. It’s just life. You’ve got to keep pushing forward.”
“You’re numb for so long. Then, when you become sober, it’s learning how to feel. I still struggle with that.”
Mike (not his real name) started using drugs shortly after his first taste of alcohol. “Growing up, there wasn’t a whole lot of drinking around me,” he said. “So when I drank the first time, I enjoyed it and I got curious.” That first sip at 14 prompted him to chase a bigger rush. Within a year, he had moved from alcohol to prescription drugs. Drugs helped him relax or cope with tough times, such as the loss of a family member, a breakup or trouble in school. Finding drugs was easy for Mike in high school and it did not take long for him to discover heroin. The drug became his crutch for getting through everything.
“If I was depressed, heroin. If I was happy, I’d do heroin,” he said.
An 80-milligram tablet of OxyContin cost him about $50, he said, while a “dub” of heroin was only $10 and provided a greater rush than Oxy. As his tolerance grew stronger, Mike’s heroin use became less about getting high and more about just feeling normal.
Mike and the friends he used with were willing to travel to dangerous houses, risking being robbed or hurt, to get heroin. Milwaukee had better deals than his hometown of Waukesha, so he and his friends piled into a car and met a dealer on a city side street. Sometimes they were too sick with withdrawal to make it back to a house to shoot up. They would drive a few blocks, pull the car over and inject right there.
Mike’s parents told him that the drugs would kill him, but that was not enough to make him quit. “In my mind, I thought I was controlling it.” Shortly after Mike’s parents confronted him, a 17-year-old friend overdosed and died. The risk of death was a necessary price for getting high, he said. “It could happen to any one of us. I knew that was a real possibility, but it never deterred me.”
Then, out of the blue, something changed. “I felt like I was at the end,” he said. “I was out of options.” Mike was admitted to Rogers Memorial Hospital and spent 10 days in detox and 30 days getting inpatient treatment. Shortly after his release, he considered using again. Triggers for relapse, such as stressful situations or former drug-using friends, were everywhere. He knew that if he gave in and smoked weed or started drinking again, he would relapse to heroin.
“I thought I was going to have to avoid everything for the rest of my life,” he said. The 12-step programs Mike attended showed him a way to cope with the triggers and kept him clean. “I sat down with these people and they had been where I had been or worse, and they talked about solutions.” He went to the meetings with his sister and a friend, both of whom are now sober.
“The only thing that ever worked for me is the 12-step program,” Mike said.
At the time Mike was getting sober, he attended programs alongside alcohol, gambling and food addicts. Heroin Anonymous groups did not begin in Milwaukee until three years ago. These groups have outgrown their original meeting spaces and now meet every night of the week. Longtime sober members branch off from the original groups to become leaders of other meetings.
While Heroin Anonymous group members are able to motivate one another to stay sober, recovering heroin users never fully overcome their addiction. They just learn to live with it.
Dr. Lance Longo, medical director of addiction psychiatry at Aurora Behavioral Health Services, said that medical treatment for heroin use is too often a cookie-cutter process, rather than tailoring the treatment to the individual.
There are not enough doctors or psychiatrists working on addiction medicine, Longo said. “There are not enough treatment centers, period.” Treatment centers are stretched to their limits.
One solution to curb the swelling number of people seeking treatment for heroin addiction is to prescribe another drug, such as Suboxone, Narcan, methadone, buprenorphine or Vivitrol, which reduce cravings or block the effects of heroin. Drug therapy helps “soften the landing” of withdrawal, Longo said, but is often expensive and does not eliminate all the reasons people use drugs. Recovering addicts should be moved out of dangerous environments and away from other individuals who use, which is not always possible.
Longo hopes that more primary service providers will offer heroin treatment services that involve friends and family in the recovery process and reduce the number of opioid painkiller prescriptions.
“Unfortunately, I don’t see any end to (heroin addiction) and, as a society, we have to accept that it’s here,” Longo said. “The medical field and society have to embrace this rather than try to detach themselves from these problems.”
The Wisconsin Prescription Drug Monitoring Program was created in 2013 so that healthcare workers can monitor what other prescribers have given individuals. Within the program’s first year, the rate of people visiting five prescribers in a month to get prescription drugs decreased by 50 percent, according to Chad Zadrazil, director of the program.
A partnership between the Milwaukee County Substance Abuse Prevention Coalition, CVS Pharmacy and the City of Milwaukee placed drop boxes for prescription drugs at City of Milwaukee Police Department offices. Michael Murphy, president of the Milwaukee Common Council, said the initiative has helped collect thousands of pounds of unused drugs. He also has proposed that the city hire a heroin and opiate victim advocate. Murphy noted that typically the county, not the city, leads drug-related initiatives. Cooperation and the sharing of resources among law enforcement and health services will be key for success, he said.
In February, Dennis Wichern, a special agent at the Drug Enforcement Administration Chicago Field Division, announced that Milwaukee will be the second Midwestern city in the DEA’s “360 Degree Strategy” to stop opioid abuse, heroin use and drug-related violence. The initiative attempts to stop drug trafficking and gang violence. The Milwaukee Police Department, Milwaukee County Sheriff’s Office, Boys & Girls Clubs of Greater Milwaukee, Safe & Sound and Partnership for Drug-Free Kids are some of the 15 organizations involved in the movement.
Longo said that there are “moral and ethical misperceptions” about heroin addicts, particularly that they are bad people rather than a victim of a disease that can affect anyone.
“There are not enough treatment centers, period.”
March 14, 2016
Addiction typically starts at home with legal drugs, according to Rusty Payne, national spokesperson for the U.S. Drug Enforcement Administration. “It all starts with the pills.”
Doctors are not only distributing a greater number of painkillers than in previous decades, they are also prescribing them too often, said Dr. Michael McNett of the Milwaukee Medical Society.
In 2013, the most recent year for which data are available, almost 207 million prescriptions were written for opioids, such as OxyContin, Vicodin and Demerol. In 1991, doctors wrote 76 million prescriptions for such drugs, according to the National Institute on Drug Abuse.
The United Nations Office on Drugs and Crime reported that the amount of painkillers prescribed in 2010 was so large that every American adult could take a pill every four hours for an entire month. The United States makes up almost 5 percent of the world’s population, yet consumes 80 percent of its narcotics.
More than half of prescription drug abusers in 2014 reported getting pills from a friend or relative, and more than half of young heroin users who inject the drug said they abused prescription opioids first, according to the National Institute on Drug Abuse. Users can take prescription painkillers the same way they can take heroin, by crushing and snorting or injecting. Since heroin produces a more intense high at a cheaper price than prescription drugs, painkillers start to look less like a gateway to heroin and more like a highway.
Heroin interferes with they way endorphins are released in the brain, causing an intense euphoria. The chemical imbalance caused by heroin keeps neurons that signal pain or discomfort from firing and the user is overcome by a sense of calm. While this process may occur naturally through exercise or creative hobbies, heroin increases the brain’s exposure to these natural painkilling hormones.
This exposure fundamentally changes brain chemistry by raising the amount of chemicals the brain requires for normal function. The user needs to take drugs more frequently or in higher doses to experience the same euphoria. “When you become an opiate addict, your body craves and craves and craves,” Payne said.
Withdrawal affects every user differently, but a high drug tolerance typically correlates with stronger withdrawal symptoms. Injecting causes an almost immediate high because blood carries the drug directly to the brain, but the chemicals are used up quickly, giving way to a dramatic crash. A body coming off such an intense high can experience a wrenching seesaw between cold sweats and hot flashes, vomiting and diarrhea.
When the body abruptly comes off of a drug high, basic functions, such as getting out of bed or going to work, seem impossible without heroin.
Clouded thinking produced by heroin dependence or withdrawal dramatically increases the risk of a fatal overdose. A typical hit of heroin causes the body to relax. The heart rate decreases and breathing slows. Ingest too much heroin and the body forgets to breathe. Blood pressure drops so low that blood barely circulates to the organs that are in desperate need of it. Brain cells start to die after five minutes without oxygen.
Drug poisoning killed nearly 44,000 people in the United States in 2013 and was the number one cause of injury-related deaths in the country, according to the National Center for Health Statistics. Through November 2015, Milwaukee County had 244 drug-related deaths, which is on pace to eclipse any year dating back to 2002.
The brain’s neural pathways cannot heal themselves once they are changed, said Dr. John Mantsch, professor of biomedical sciences at Marquette University. These changes stay with the user, regardless of whether it has been 10 minutes or 10 years since the last high. People who achieve sobriety have a greater risk of relapsing because the neural pathways are changed. Mantsch calls heroin addiction the “battle that lasts a lifetime.”
Doctors, drug experts and researchers weigh in on the psychological and biological effects of addiction.
Since heroin produces a more intense high at a cheaper price than prescription drugs, painkillers start to look less like a gateway to heroin and more like a highway.