Jack had moved to Seattle for a geographic detox, physically removing himself from the source of the drug and influence from acquaintances in the scene. According to friends Jack had been clean from heroin for three months. His mother speculates that his inhibitions may have been lowered on the long trip home, perhaps with a little booze. By the time he reached Boise, he just wanted to party, like old times. Jack was 22 years old when he died.
His friend Joe said Jack was the second person he'd known in the past year to overdose. Friends and family think his death could have been avoided if adequate treatment had been available in Boise.
On the morning of January 19, 2005, Boise Police, the Ada County Metro Drug Task Force, Immigration and Customs Enforcement, the ATF, DEA, Idaho State Police, Nampa Police, Canyon County Narcotics Unit and the Blaine County Sheriff's Department's Narcotics Enforcement Team arrested nine suspects, searched nine homes and confiscated seven ounces of heroin and cocaine. After a four-month investigation into what police claim were three separate drug rings, officers arrested who they believe were the dealers providing much of the heroin to high school-aged kids in Boise and the surrounding area.
Police estimate that this group was bringing approximately 73 pounds of heroin into Idaho every year. Using the police-estimated average consumption rate of two-tenths of a gram per heroin user per day, one can estimate that approximately 450 local heroin users were supplied by this group of dealers. Annually, users may have spent as much as $3.3 million on heroin with this group of dealers alone.
Current and recovering heroin users interviewed by Boise Weekly for "Chasing the Dragons" (BW, December 19, 2004) confirmed that those arrested were the dealers providing heroin to them and other teenagers in Boise, but they were not the only sources of heroin in the Treasure Valley. Sources close to Jack Barsness say that those arrested weren't providing heroin to their circle of users.
Heroin has always been a problem in larger cities and metropolitan areas, and some Boiseans are shocked that it is here in Idaho. At some level it has been here for quite some time. But before the community attempts to deal with growing concerns that heroin is here and may be here to stay, it is important to understand what heroin is and how it affects those who use it.
What is heroin?
Heroin was first synthesized in 1874 from morphine, which is derived from a naturally occurring substance in the seed pod of poppy plants. By 1898 heroin was being used by doctors to treat pain but by 1914 abuse of the drug forced the federal government to ban its use with the Harrison Narcotic Act. Natural opiates from poppies and synthetically produced opiates are used today to produce a wide variety of controlled and legal pharmaceutical medications. The medical class of opiates is wide ranging and has beneficial effects in pain management by blocking pain receptors in the brain.
Who does heroin and how do they do it?
The stereotype that heroin users are all junkies who have track-marks from needles is part of the non-drug user mythology. Heroin users in our communities are kids from middle-class and wealthy families, truck drivers, state workers, lawyers and maybe your next door neighbor. There are many cases where lifelong addicts have been able to maintain productive careers. The pioneering surgeon William Halstead was addicted to morphine during most of his professional career, unbeknownst to his colleagues.
Heroin comes in two forms--powder and black-tar, a sticky black substance usually sold wrapped in a small rubber balloon. This is the type typically sold in the Treasure Valley.
Heroin can be ingested in many ways. Black tar heroin can be smoked, cooked (liquefied using heat) and dripped down the back of the throat or cooked and injected into the bloodstream. Powdered heroin can also be snorted like cocaine. Some users justify their use of heroin by believing that as long as they aren't shooting it up with a needle, the social line that determines a junky in some users' minds, they are not junkies.
However heroin enters the body, it rapidly enters the bloodstream and begins to cross the blood-brain barrier. In the brain, it is converted to morphine and binds with receptors normally reserved for naturally produced endorphins. Users report a "rush," and its intensity is primarily determined by how rapidly the drug enters the brain and attaches itself to open receptors. The side effects of the drug can include a warm flushing of the skin, dry mouth and a heavy feeling in the extremities. It may also be accompanied by nausea, vomiting and severe itching. Users may seem drowsy for several hours after using and mental function is clouded. Users are often seen nodding out as drowsiness leads to sleep. Cardiac function and breathing may slow or even stop in the case of overdoses. The unpredictable purity of the drug due to dealers diluting their product may result in undetermined strengths and occasional overdoses. Users typically overdose by consuming too much for their tolerance level which leads to the stopping of the heart or loss of consciousness and subsequent choking on their own vomit.
Heroin is perhaps one of the most addictive opiates, legal or illegal, in the drug world, due to how it interacts with the brain. Tolerance levels quickly increase with continued use, and users may find that to get the "rush" from using heroin they must ingest greater quantities each time they use. Long-term heroin use creates physical dependence through neurochemical and molecular changes in the brain. Tricked into short-circuiting, the brain stops producing natural endorphins and instead relies upon provided opiates. The brain ceases to operate normally, suffering withdrawal symptoms and driving users to seek out heroin to feed the brain the chemicals it once provided for itself.
Other long-term effects may include rheumatoidal problems, arthritis and the potential transfer of blood-born diseases such as HIV/AIDS and hepatitis B and C when needles are shared. Heroin that is cut (diluted to increase the amount available for dealers to sell) may contain substances such as sugar, starch, powdered milk, strychnine or other poisons and may have unintended short- and long-term side effects. If the drug is taken away, the body reacts violently.
Withdrawal and detox
Withdrawal symptoms may appear within a few hours from the last time the drug was ingested. Without opiates to take the place of endorphins, the brain becomes super-sensitive to pain and triggers a plethora of side effects in order to compensate. Often, the symptoms of withdrawal are exactly opposite to what the drug provides the user. Heroin withdrawal may include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes and seizures. Symptoms increase over 24 to 48 hours when major withdrawal symptoms develop.
According to users who have gone through complete withdrawal from heroin, it feels like they are going to die. Fortunately, in healthy adults heroin withdrawal is usually not fatal, although it can cause death to the fetuses of pregnant addicts.
Sometimes users decide to subject themselves to withdrawal and detoxification to lower their tolerance to the drug. In such cases, when they return to the drug, they are able to experience a bigger euphoric effect.
Withdrawal symptoms not only vary between the amount of heroin a user may be using, but also between individuals. Drug researchers Norman Zinbreg and David C. Lewis described five categories of narcotic users including one group "who use narcotics regularly, but who develop little or no tolerance for them and do not suffer withdrawal symptoms."
All too often, however, the withdrawal and detox process is severe, sometimes taking two to three weeks before natural endorphins begin to be produced by the body.
"I checked myself in to the Walker Center," said George, an area high school student whom BW interviewed for "Chasing the Dragons." "I had the worst withdrawal they had ever seen. Up for four days straight. I was completely naked sitting in the shower thinking to myself the only thing I want to take off now is this fucking body. I just wanted to get out of my body for a couple days. I wanted it to be like a movie. I wanted it to be one week later. Every minute, you're counting every minute. Your body just feels dead. You get in a really deep depression. You doubt yourself, you doubt your friends, you doubt your entire being. It's shitty. It's just so shitty."
Detox is the body ridding itself of the physical addiction to drugs. Dealing with the mental addiction and the underlying reasons for use is, to most, even more difficult.
Some come to the conclusion naturally, perhaps having a "eureka moment." Maybe they almost overdose or a friend close to them dies from using. Others need an intervention, friends and family who come together to confront the user to address his or her problem.
"Everyone realizes his time has come," said George. "Otherwise you will find the ultimate low. My brother walked in as I was about to take a shower. He looked at me in my eyes and asked me 'What are you doing with your life? Your friends are coming over and telling mom they think you're going to die. Not why, but that they're scared.' After my friend John went to rehab I wanted to seek that ultimate low. I shot up one time, and I woke up nine hours later, hadn't moved an inch."
Getting off addictive drugs and staying off can also prove difficult for some addicts.
"Every day is a struggle, man--every single day," said George's friend John, an area teenager who is staying away from heroin after attending the Walker Center, a drug rehabilitation facility in Gooding. "Think about it. You drive by a place and go 'I used to do dope there. I did drug deals there.' You see friends on the weekend and they're at a huge party, five kegs, a bunch of alcohol. What do you do? So yeah, I got drunk a few times, I smoked some pot. You go to rehab and you realize you are an addict. You smoke some pot and you go 'Fuck this, I want some heroin. I want some crack.'"
Contemplating his decision to go through detox and rehab, John recalled, "It's not the life to live. Getting up every single day and not being able to get out of bed until you take that hit, get that chemical in your body. When you can't make it to the toilet before shitting all over yourself or puking all over yourself ... that's fucked up. That's when you know your life has really gone down the drain."
The 2002 study Treatment on Demand: The Need for Substance Abuse Detoxification in the City of Boise/Ada County by the Center for Health Policy at Boise State University reported the alcohol and drug detox need in Ada County is estimated to be 310 to 330 individuals per month (incorrectly reported as 300 per year in other news sources). The number of detox beds available is far below that number. In a 10-county area in Southwestern Idaho there is only one state-funded bed available for detox--Port of Hope in Nampa.
Despite the need for detox and rehabilitation services in Boise, local governments have done little to move forward with plans. St. Alphonsus Hospital estimates it would cost $3 million to maintain a detox facility, but they would require help with the $5 million needed to build it. Former Mayor Brent Coles earmarked $700,000 for a detox facility, but after scandals forced him from office, the federal money was redirected to community housing.
Melanie Curtis with Supporting Housing and Innovated Partnerships thinks it could be done at a much lower cost. She is trying to open a twelve-bed, clinically managed detoxification clinic in Boise and estimates it would cost only about $425,000 per year once a building is purchased. Also involved is Charlotte Lanier, Jack Barsness' mother and some of his friends who recently raised $4,500 for the detox center at a recent benefit fund-raiser in Jack's memory. Community detox center advocates are hoping that the city will come forward to purchase a building and equipment.
"It would be more than a bed and a bucket type of place," Curtis said. She said there are two types of detox models: the medical model and the social model. The medical model is typically directed by physicians and other health-care personnel and involves the use of pharmaceutical drugs to lessen the symptoms of withdrawal. Typical costs for a medical model detox are $700 to $800 per day, according to the Treatment on Demand study.
The social model concentrates on providing psychosocial services for detoxification and only refers patients in need of medical services. It is a drug-free process, and the typical cost is around $140 a day.
There are other options for those wishing to pursue alternative recovery. Cliff and Billi, both Boise addicts who have struggled with rehabilitation, contribute to and operate www.opiophile.com, a membership driven discussion board established in early 2004 for opiate addiction information.
For years, Cliff has been on and off heroin, tried just about every alternative to detox and has even detoxed in jail. Accepting his addiction as part of his life, he has pursued drug options such as methadone, buprenorphine, alternative methods and other legal means to satisfy his brain's craving for opioids. His self-education has led him to set up the site to help him determine "where his cravings are coming from." He has even satisfied his brain's cravings with poppy seeds bought in bulk from local grocery stores. He feels it is important to have a peer group to share information and support, part of his decision to start the Web site.
Billi's history with addictive drugs is similar. He has gone through rehab, tried medical and social models for detoxification, even geographic detox. He began drinking heavily to fight his opioid cravings and is currently under a doctor's care following a buprenorphine program but feels it will be a lifelong struggle for him.
Would it be easier to deal with addiction if there were more options available? "Absolutely," both Billi and Cliff said. The impact would affect much more than local addicts. It would have a profound effect upon the community.
Curtis sites figures (some from the Treatment on Demand study) that estimate $300,000 per year is spent on police officers' time alone dealing with incapacitated persons detoxing. Hard-core addicts often result to petty theft and burglary to support their habits. The criminal justice system is filled with cases of crimes resulting from drug use.
According to the National Center on Addiction and Substance Abuse, 97 cents of every dollar spent on substance abuse is categorized as a burden to public programs including court costs, prison costs and public medical costs. Just three cents of that dollar is spent on prevention and treatment. The California Department of Alcohol and Drug Programs reported in 1994 that every dollar invested in prevention and treatment saves seven dollars in impact on public programs. In 1998 alone, Idaho spent $237 million on substance abuse, of which only seven million on prevention and treatment.
While the recent arrests made a big dent in local heroin availability, what will all those users do now? One cannot assume that all are willing and able to quit, either mentally, physically or financially. Making the decision to stop using heroin, by choice or not, depends upon a variety of factors. And many wonder how difficult it will be.
Without adequate detox and rehabilitation services and support in the area, both socially and medically, the decision to quit is often delayed for users. Those who are unwilling to deal with the potentially painful withdrawal symptoms may find other medications to ease the pain. Some turn to alcohol, others pharmaceuticals such as Oxycontin or other opiates which may be acquired through legal or illegal means. Now that some of the heroin is gone from our community, what do we do to treat those affected by it?
Plans for other fundraisers for a Community Detox Center are in the works including Rock for Detox. Those interested in more information may e-mail firstname.lastname@example.org.