Editor’s note: Students at Arizona State University’s Cronkite School of Journalism produced a 30-minute documentary, “Hooked: Tracking Heroin’s Hold on Arizona,” that aired last week in collaboration with the Arizona Broadcasters Association. As part of the project, students also wrote about the heroin epidemic in Arizona. The Mohave Valley Daily News is printing several of those stories in today’s edition.
Logan Spude lay on the floor covered with a sheet, his body still warm, even as paramedics declared him dead at 4:33 a.m. His pockets held a wallet and a can of Grizzly long-cut tobacco. His black sneakers rested where he left them, right by the front door.
Just hours after leaving the Verde Valley Guidance Clinic the afternoon before, Spude relapsed by shooting up heroin in the parking lot of a local Clarkdale Walmart, where he and an acquaintance had just purchased a 10-pack of syringes, some spoons and water.
Early the next morning, too high to get back to his sober living home, he fell asleep on his friend’s floor and never woke.
Spude had tried to stop his addiction multiple times. He was 26.
“Drugs have never been discussed in this town. Ever. Ever. It’s pretty much a ‘no see, no talk,’” his mother Barbara Spude said. “Only when Logan died did I have nine moms, because I was counting them … nine moms come to me and tell me that their children were addicted to heroin and they didn’t know what they were going to do.”
At its worst, the life of a heroin addict is deadly and unforgiving. From 2010 to 2013, drug deaths topped even the number of motor vehicle deaths in Arizona with 1,106 drug deaths compared to 711 motor vehicle deaths in 2010 and 1,200 to 770 in 2013, according to yearly reports from the Arizona Department of Health Services.
Although these numbers represent all drug deaths and not just those that are heroin-related, a report by the Substance Abuse and Mental Health Services Administration showed people aged 12 to 49 who had used prescription pain relievers non-medically were 19 times more likely to have initiated heroin use recently than others in that age group.
“We have seen an increase (in heroin deaths) and that’s really why we addressed it in our prescription drug initiative, because prescription drugs are obviously tied to heroin rates and consequences,” said Kelly Charbonneau, the substance abuse grant coordinator for the Arizona Department of Health Services.
Doug Coleman, Special Agent in Charge of the Drug Enforcement Administration Phoenix Division, also attributes much of the heroin problem to the abuse of prescription pain medications.
“The main reason for that is the prescription drugs that are abused the most are the opiate-based prescription drugs; the oxycontins, the oxycodones, the hydrocodones,” Coleman said. “We’re seeing a switch over to the heroin because … getting the pills has become not cost effective and the flooding of the market with the heroin is leading to decreased prices of heroin because there’s more of that commodity on the market.”
Logan Spude first began abusing alcohol as a teenager, his mother said, after his brother, Ryan, died in a car accident. He began smoking marijuana at 16, abusing prescription drugs at 17 and then eventually heroin at 21.
Before his death, Logan had been clean for four months, his mother said. Court documents corroborate Logan’s struggle, as he went in and out of relapse at least twice in 2012 and 2013. She said he had started using his connections to help other addicts.
“He was starting to mentor other heroin users,” Barbara Spude said. “He had a young girl named Brittany Lynn. He was starting to mentor her about heroin and get her off. They were working on it together.”
She also died only a few months after Logan Spude from what the Yavapai Medical Examiner’s Office said was a methamphetamine overdose.
“They were becoming buddies and she looked up to him because he was older; she was 21,” Barbara Spude said. “She and Logan were really, really close and it (Logan’s death) was a little more than she could handle.”
The National Survey on Drug Use and Health places the average age of the typical heroin user in the range of 18 to 25.
“It’s alarming for me to watch this happen because I know what addiction does and I know that adults aren’t capable of handling addiction,” Coleman said. “Seventeen, 18, 19-year-old kids certainly have no chance of handling addiction if they go down that path.”
Logan was in drug court the day he died for a previous charge of possession of drug paraphernalia.
“What I have seen in just the two years since I have been here is quite a rise in the amount of heroin that is being used in this community,” said Clarkdale Police Chief Randy Taylor, who responded to the 911 call the night Logan died.
“I remember it wasn’t even on the radar when I got here, we didn’t even talk about heroin. We knew that heroin in the area was there but we never anticipated it being at the epidemic level that it is at now,” he said.
In October, the Centers for Disease Control and Prevention reported that heroin overdose deaths across the country have increased from 2,679 in 2010 to 3,635 in 2012. Arizona was one of the 28 states cited in the report for an increase in heroin deaths..
Natasha Gates, a 28-year-old mother, was among them. She died of a heroin overdose in a cold-water bath in October 2012.
Her mother, Colette Williams, said her daughter was a talented person, as evidenced by her good grades and accomplishments with the alto saxophone. She was overall a “pretty bubbly” person.
But she was having a hard time juggling her job and the responsibilities of raising her son, Blake, who was 5 years old at the time.
“We knew that, yes it was a tough time,” Williams said. “I mean, she was hating work at the moment she, as I said, you know the whole family ideal just kind of got shut down and yes she was in pain and all of us repeatedly asked her please tell us what’s going on.”
According to Maricopa County court documents, Gates brought heroin to the house of one of her friends’ roommates to “get high. ” After smoking some, she asked him to inject her with more.
Passed out from the heroin, her friend and his roommate partially undressed her and put her in a bathtub filled with cold water to help suppress Natasha’s overdose symptoms. Both fell asleep and when they woke, she was dead, according to the records..
“Anguish, immediate anguish,” Williams said on how she felt when she found out about her daughter. “You know, I had the feeling that something bad was going to happen and I just never thought it would be Natasha that I’d be worrying about. She had been so great at raising her son, getting through work and finally living on her own and taking care of herself. Never thought this would happen to her.”
The state of Arizona is attempting to curb the increased heroin death rates at the source, according to Charbonneau of the state health department.
Charbonneau is helping coordinate better substance abuse policies designed to educate first responders, state-run clinics and other agencies with the right know-how to help treat opioid abusers like heroin.
“I think it was just so shocking for all of us in the manner that she had died and how it would’ve been so easy to save her life and I think it took all of us a long time to accept that fact; we were very angry as well as just broken-hearted,” said Williams.
First responders, hospitals on front lines of crisis
By LAUREN LOFTUS
and CARLENE REYES
When Brooke Marcus came to from her last heroin overdose, she was surrounded by paramedics.
It was July in Phoenix. She had collapsed onto searing asphalt. The paramedics had brought her back to life, but Marcus was angry.
They had ruined her high.
She also was scared, but not because she came so close to death.
“I remember being in an absolute panic because I didn’t have any money,” she said. “My thoughts were, ‘How am I going to get more dope?’ ”
The 46-year-old remembers paying someone $10 to inject her with heroin that afternoon in 2010.
She was holding on to a chain-link fence behind a restaurant on Van Buren Street and knew immediately she was overdosing.
“I remember I had to hang onto the fence because it got me instantaneously,” she said. “You get a moment of clarity right before you lose consciousness where you automatically know you’ve done too much. You try to pull yourself back and you can’t.”
Paramedics took her to St. Joseph’s Hospital and Medical Center despite her protests.
Marcus was there for about 10 minutes before she walked back into the heat in search of her next fix.
Going too far
An overdose occurs when a person takes too much of a drug, or a combination of drugs, for the body to process.
Heroin users are particularly prone to overdosing because their drug of choice is usually mixed with unknown substances, making it difficult to know the purity. A single dose with a higher concentration of heroin can be dangerous for those who usually take lower concentrations.
Heroin is a highly addictive narcotic opioid that is synthesized from the painkiller morphine and causes a euphoric high when ingested, snorted, smoked or injected.
Janet Backers, a registered nurse and director of the emergency department at Tempe St. Luke’s Hospital, said heroin users never know exactly what they’re getting.
“It’s being cut with other medications. Substances like codeine. Substances like meth,” she said. “It’s also being mixed with over-the-counter medications, alcohol and prescription medications.”
Heroin converts to morphine in the brain and binds to cells known as opioid receptors. These control respiration, among other things. When a user overdoses, the body forgets to breathe properly or at all.
A Cronkite News analysis of public records from the 2009-2013 Arizona Hospital Discharge Data Set, which is gathered by the Arizona Department of Health Services’ Bureau of Public Health Statistics, showed there were 2,050 heroin overdoses reported in Arizona during that period. Overdose cases have gone up each year, from 277 in 2009 to 562 in 2013, the analysis found.
RJ Horton, a recovering addict and student at Arizona State University, overdosed on heroin five times in four months.
A 20-year-old from Scottsdale with a penchant for Converse sneakers, Horton said he first became addicted to prescription painkillers at 16 after a sports injury.
He later discovered that it took a lot less heroin to produce a high than prescription pills. After smoking it during his first semester at ASU, a friend persuaded him to shoot it.
“I saw someone was doing it,” he said. “They were like, ‘If you’re going to do drugs, this is the only way to do it. It’s more efficient.’ ”
Injecting heroin produced a more intense, quicker high than he had experienced.
“It honestly feels like God’s just cradling you. You’re just OK,” he said. “My whole life, I’ve tried to chase that high, and I happened to find it in heroin.”
But that feeling didn’t last long.
“Everything’s OK at the time, but as soon as it wears off you’re miserable again.”
Heroin users build their tolerance quickly, so they need more of it to produce the same euphoric high.
Not knowing what the heroin is cut with, coupled with the fact that users build up tolerance and need more of the drug to get high, means overdoses can happen at any time, especially when a user injects it.
“You’re really playing Russian roulette every time you shoot up,” Horton said.
Three times when he overdosed, Horton came back on his own. The last couple of times, he needed medical intervention.
“It feels like you’re getting stabbed with a bunch of needles all over,” he said. “And then you just kind of pass out.”
Between 2009 and 2013, there were 1,240 narcotic overdose cases in Maricopa County, or a rate of nearly 31 per 100,000 people, according to the Cronkite News analysis of state data.
Unconsciousness and shallow breathing are the telltale signs of a narcotic overdose.
Capt. Robb Anders, a paramedic with Tempe Fire Department, said firefighters use an “unconscious protocol” when they respond to a suspected overdose.
“We would assess his breathing, open his airway,” he said. “Is he blue? We look at the eyes. Your pupils have a very reactive response, or lack of response, to narcotics.”
And it all happens in a matter of seconds.
On a suspected overdose call in Tempe, at least two paramedics in a fire engine plus an ambulance with emergency medical technicians are dispatched. According to Anders, their average response time is 41/2 minutes.
Once on scene, they work quickly, and their speed is mirrored in their best line of defense: Narcan.
The brand name for nalaxone, Narcan is an opiate blocker that can help the body breathe again. When administered via nasal spray or injection, Narcan triggers immediate withdrawal.
Tempe Fire Deputy Chief Darrell Duty said the drug only works in reversing narcotic overdoses.
“Narcan basically binds to the receptors in the brain, and it won’t allow the heroin to bind to those receptors,” he said. “So that person’s high goes away immediately as soon as the drug takes effect.”
Narcan is often considered a kind of miracle drug, bringing back overdose victims from the brink of death. But if a person doesn’t get it soon enough, Captain Anders said there’s little paramedics can do.
“Unfortunately, we don’t get them back,” he said. “They’ve been found too late … their brain hasn’t had enough oxygen.”
The spontaneous withdrawal can ignite different reactions in those who are overdosing, including becoming physically violent or violently ill.
Horton said he remembers being very confused when paramedics injected him with Narcan the last time he overdosed a year ago.
“Your whole body is rebooting itself. Kind of like a computer when you start it up,” he said. “It puts you into instant withdrawals.”
Symptoms of withdrawal from narcotics include vomiting, chills, body pain and insomnia.
According to Deputy Chief Duty, it’s understandable that the person who was just saved shows little to no gratitude.
“If you can imagine, just put yourself in that person’s position – you’re basically in a euphoric state, and then the next thing you know there’s a bunch of people around you, poking you with needles and holding you down,” he said. “Some people would react violently to that.”
Brooke Marcus, who has overdosed at least five times, said withdrawal is extremely painful.
“It feels like you’re going to die,” she said. “Imagine the flu magnified by 50.”
That withdrawal mimics what happens to the body when a heroin user voluntarily detoxes, except a Narcan withdrawal is unexpected and unwanted. According to Marcus, when overdosing users are forced into withdrawal, all they can think about is getting more heroin.
“When you get Narcan, you’re sick but you know if you just go get another $10 worth of heroin, you’ll be fine,” she said. “You can fix it that quick.”
But it didn’t matter how badly she needed it. Arizona emergency response protocol is to transfer every overdose case to the hospital.
Narcan may bring addicts back from the brink of a lethal overdose, but it’s not a cure-all.
According to Dr. Richard Rosenthal, emergency room director at Tucson Medical Center, the effects of Narcan can wear off before the heroin does, meaning it’s possible to relapse into an overdose.
“Narcan lasts for maybe a half hour to an hour and (a heroin high) has got a few hours or even four or five hours,” he said.
That’s why Rosenthal said the primary goal of emergency room staff is to keep overdose patients in the hospital as long as possible to monitor respiration and cardiac function.
“Then we try to work on the social aspects of it, trying to get them into some kind of program,” he said.
At Tempe St. Luke’s Hospital, Janet Backers said she’s seen an increase in narcotic overdoses in the past several years.
According to the Cronkite News analysis of state data, Tempe St. Luke’s had the state’s fourth-highest number of admissions for heroin overdoses between 2009 and 2013, treating more than 115 people.
“It’s a small community,” said Backers, noting the hospital’s proximity to ASU’s Tempe campus. “There’s really only one health care system within Tempe proper.”
Once overdose patients are stable, she said, staff will encourage them to seek further treatment. However, it’s rarely something an addict wants to hear.
“You’re not going to treat someone that doesn’t want to be treated,” Backers said.
Almost all heroin overdose cases in Arizona survive if they make it to the hospital, but a majority of them leave without seeking further treatment.
According to the Cronkite News analysis of state data, 89 percent of all overdoses between 2009 and 2013 were discharged to self-care or left against medical advisement.
Chip Coffey, director of outpatient services at St. Luke’s Behavioral Health Services, said he rarely encounters heroin addicts who are ready to get help on their own immediately after an overdose.
“There is this Superman or Wonder Woman complex about how impervious they are to death,” he said. “On the other side, you get ones who know they’ve almost died. Maybe this is their fourth or fifth time overdosing and what they’ve done is they just give up.”
RJ Horton said his parents tried forcing him to get clean, but it took a friend overdosing and dying for him to seek treatment on his own terms.
“I can’t do this anymore,” he said. “This was my moment of clarity. I truly wanted to be sober, and I was tired of living in misery.”
Late in 2014, Horton was four months clean and living in a halfway house in Phoenix with other recovering addicts.
“Today I get my ‘shot of dope’ in other things,” he said.
He’s dedicated to school, he exercises regularly and he spends most Sundays going to Cardinals games with his dad, things that he said help him stay clean.
Brooke Marcus said she never had an “aha” moment. After years of supporting her habits through prostitution, she grew tired of her routine.
“There was no real motivating factor other than the fact that I didn’t want to prostitute myself for $60 to get through the day anymore,” she said.
She’s relapsed several times over the years but said she’s doing everything she can to stay clean this time around. The horror of detoxing is a big motivation for staying off heroin.
“I’m not 21 years old. Getting money and hustling is a lot different,” she said. “I’m too old for it. I don’t want to do it anymore.”