The death of her 18-year-old daughter, Ashley Elder, from a heroin overdose remains an ever-present reality for Roberta Lojak.Steve Mellon, Post-Gazette
Roberta Lojak holds a high school graduation picture of her daughter Ashley Elder, who died of a heroin overdose in October 2001. Lojak is standing in a garden she planted in her daughter's memory.
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Nearly three years later, the horror of finding her daughter unresponsive in bed, then trying unsuccessfully to revive her, has barely begun to fade.
"I'm the one that found her, did CPR on her," said Lojak, 45, of Fawn.
"For me, it seems like yesterday. I can't accept it any more than the day it happened."
Her daughter's death in October 2001 is one of a growing number of accidental drug overdose deaths in Allegheny County.
Last year, 229 of those deaths were reported, more than twice the number in 1999, according to the Allegheny County coroner's office.
The totals involve both county residents and non-residents. Suicides and homicides are not included.
While some of the deaths occurred from inadvertent overdoses of prescription drugs or interactions between those drugs, the vast majority were from substance abuse, said Steve Koehler, a forensic epidemiologist with the coroner's office.
The Allegheny County Health Department also reports an increase in accidental drug overdose deaths among county residents.
In the past decade, those deaths never reached 100 a year until 1999, when 109 deaths were reported. Last year, 176 deaths occurred.
Accidental overdose deaths also have increased among state residents, from 694 in 1999 to 1,121 last year, according to the state Department of Health.
Deaths also have increased in other states. An analysis released this year by the Centers for Disease Control and Prevention found that from 1990 to 2001, death rates from unintentional and undetermined poisonings increased by an average of 145 percent in 11 states studied. Among U.S. adults, drug overdoses are the leading cause of poisoning deaths.
Health professionals, law enforcement personnel and others attributed some of the increase in local overdose deaths to heroin that is purer, more addictive and more deadly. In recent years, similar problems with heroin have been reported in other U.S. communities.
Authorities believe the purer heroin attracts users reluctant to inject drugs. Once about 10 percent pure, heroin is now 70 to 90 percent pure, strong enough to induce a high by being snorted.
"When it's that pure, it's more likely you'll overdose," said Dr. Neil Capretto, medical director of Gateway Rehabilitation Center.
In Allegheny County, 44 percent of last year's accidental overdose deaths were caused by heroin, either alone or in combination with other drugs.
Another factor in local overdose deaths, authorities believe, is the availability of prescription drugs.
Many drugs are readily available through Internet pharmacies, said Dennis Johnson, a supervisor in the Pittsburgh office of the federal Drug Enforcement Administration.
The number of those pharmacies has increased nationwide from about 140 in 2000 to about 1,500 now, he said.
Locally, criminal cases for the painkiller hydrocodone, also known as Vicodin, have continued to increase, Johnson said, and make up about 70 percent of the local DEA office's case load involving pharmaceuticals. Cases involving the more powerful painkiller OxyContin have declined.
Johnson said drug abusers using OxyContin frequently move to heroin because it is cheaper.
Gateway saw its first patient for abuse of OxyContin in 1999, Capretto said. Since then, the center has treated about 2,000 patients for abusing the drug.
Capretto said one of his patients paid about 50 elderly people to obtain the painkiller from their doctors.
"That's kind of extreme," he said, "but it's pretty common for people to obtain some OxyContin from other people getting it legitimately, either paying them or stealing it from them."
The problem is not limited to adults.
"Our kids have told us they can easily get hold of Vicodin and OxyContin," said Margie Modro, a clinical educator for addiction services at Western Psychiatric Institute and Clinic who works with area schools. She expressed concerns that methamphetamine use, a problem in other communities, would soon surge in the Pittsburgh area as well.
Capretto and Dr. Oscar Bukstein, an associate professor of psychiatry at WPIC, said a near-epidemic problem with heroin use also has occurred in recent years among area adolescents.
"There are so many in every community," Capretto said. "We have kids from good school districts who tell me 17 of their 19 friends are doing heroin."
The substance abuse problem extends to a range of income groups and neighborhoods, said Deb Kehoe, executive director of the Northern Area Alliance Against Highly Addictive Drugs, which works in 12 school districts in Allegheny and Butler counties.
In Allegheny County, accidental overdose deaths also have been reported over a wide area. Last year, those deaths occurred in about 30 neighborhoods within the city of Pittsburgh and more than 50 other municipalities.
Many of the deaths occurred among people in middle age, especially white men. Males have always been associated with greater use of street drugs, and whites are more likely to abuse heroin and similar drugs, said Dr. Len Paulozzi, a medical epidemiologist in the CDC's division of unintentional injury prevention.
More deaths may occur to people in middle age, he said, because they may have developed addictions requiring high levels of drugs.
In Allegheny County, the number of deaths also has increased among young people. Twenty-one people younger than 25, including four teens, died last year of accidental overdoses, up from 5 deaths in 1999.
Advocates believe that more should be done to stem the tide of overdose deaths.
In Western Pennsylvania, advocates believe improved prevention efforts and treatment options are needed. Local treatment programs often have waiting lists.
Capretto said greater availability of treatment could reduce the costs of long-term addiction on the health care and criminal justice systems.
After learning her daughter was using heroin, Roberta Lojak said she was unable, at first, to place her daughter in treatment. She said programs turned Ashley away, saying she didn't appear to be actively abusing substances.
Enrolled in the gifted program at Highlands High School, Ashley was "the last person you'd ever think would do drugs," her mother said.
She worked part-time in a convenience store, never stayed out late or got in trouble.
But her mother noticed a change in the spring of 2001, Ashley's senior year. Her speech slowed and she often fell asleep sitting up. She began showing up late for work, wrecked her car twice and began spending time with a new group of friends.
Her mother still didn't suspect drug abuse until someone called and informed Ashley's father. Lojak said Ashley was snorting heroin, introduced to the drug by a young man she was interested in, and appeared to be hooked.
"I think the drugs are so much purer, you can get addicted after trying it once," Lojak said.
In the months that followed, Ashley went through drug withdrawal at home twice, experiencing several days each time of sleeplessness, nausea, chills and muscle spasms. But she continued to be gripped by addiction.
Lojak remembered asking, "Ashley, aren't you afraid you're going to die?"
"No, Mom," her daughter replied. "I know what I'm doing."
Lojak said she was able to get Ashley admitted to an outpatient treatment program, but it didn't seem to help. She eventually had her daughter committed involuntarily for treatment.
She was in that program three days and, a week and a half later, spent 10 days in another treatment program.
She spoke then of wanting to overcome her addiction, her mother said. She also had written her mother a letter expressing regret for some of her actions and mentioning hopes for her future -- hopes of traveling and becoming a counselor.
Believing her daughter needed more intensive care, Lojak brought her home that weekend and scheduled an appointment with another treatment program the following Monday. But when she went to wake her daughter that morning, she found her unresponsive, still gripping the television remote with her hand. Her fingernails were blue.
Lojak, a nurse, tried frantically to revive her. She said her daughter apparently had slipped away and bought drugs the day before.
Since then, dealing with the loss has been difficult. Lojak said she copes by focusing on her 18-year-old son and 13-year-old daughter.
She also speaks to community groups about Ashley and has planted a garden in her memory that includes varieties of daisies, her favorite flower.
"Everybody tells me life goes on," Lojak said. But the painful memories and sense of loss remain.
"No one is too good to get taken over by this," the grieving mother said of drug addiction. "It can happen to anybody."
Joe Fahy can be reached at firstname.lastname@example.org or 412-263-1722.