HEROIN'S SIREN SONG

Medics, doctors battle drug overdoses as Pittsburgh region sees rise in substance abuse

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City paramedics were dispatched several weeks ago to a traffic accident in Beechview: A car had sheared off a utility pole.

When medic Dan Capatolla and his crew arrived, they found a 20-something driver uninjured by the accident but barely breathing. An uninjured passenger, his girlfriend, said they had just shot up heroin.

The patient was in respiratory failure -- the effect that an overdose of heroin or other opioids such as the painkiller OxyContin can have on the brain. If untreated, the driver would stop breathing entirely. Then his heart would stop beating and he would die.

In such overdoses, medics use a breathing bag to get oxygen into the patient's system, then administer Narcan, an opioid antagonist that reverses the drug's effects. Overdose victims immediately wake up, no longer feeling any effects of the drug.


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The medics saved the young man that day, but Mr. Capatolla and others on the front lines are facing more work than ever as the region is experiencing unprecedented levels of heroin use and opioid abuse.

"It's like 'Groundhog Day,' " said Mr. Capatolla, a city medic for nearly 30 years, referring to the 1993 movie in which the character portrayed by Bill Murray experiences the same day over and over. Medics are getting so many calls for overdose patients -- in cars, restaurant and gasoline station bathrooms, residences, alleys -- "that it has kind of become routine," he said.

"There's not a week that goes by that we don't wake up one heroin overdose," and oftentimes more, Mr. Capatolla said. "And it could be in any part of the city. There are no [boundary] lines for heroin."

The suburbs are likewise experiencing an explosion of heroin use.


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Bryan S. Kircher, executive director of Ross/West View Emergency Medical Services, said that in the 26 years he's been a medic, he's never seen such frequency of heroin overdoses -- his service responds to as many as 16 cases a month. And like Mr. Capatolla, he sees it affecting all socioeconomic groups and all ages, from teens to those in their 50s and even their 60s.

Years ago, he noted, calls for heroin overdoses were unusual but now, "it's another day at the office."

Mr. Kircher said medics often save overdose patients they have saved before. He recalled one woman medics revived from a heroin overdose when she was 18. At the time, she had the vibrant look of youth.

Flash forward three years. Medics responded to an overdose involving the same woman. "She almost looked like a 60-year-old," he said.

Mr. Capatolla responded several weeks ago to a call involving a woman not breathing in a car in Allentown. They revived her and Mr. Capatolla repeatedly asked her age because he wasn't sure he was hearing correctly when she said 28.

"She looked like she was in her late 50s. It's unbelievable how that drug beats you up."

Medics explain to overdose patients that they were near death, that "'You were as blue as our [uniform pants].' We do let them know they were close to death," Mr. Capatolla said.

To most, it doesn't matter. Medics have "woken up" an addict and hours later have responded to an overdose call for the same person. In other cases, they have received so many calls that they know the addict by name.

"It continues to grow; it's apparent," Mr. Kircher said. "I don't think it's reached its peak yet."

 

Fraction of users seek help

Revived overdose patients are advised to let medics take them to a hospital emergency room for monitoring for an hour because it is possible the Narcan will wear off and the effects of the heroin will reappear.

When they're brought to Jefferson Regional Medical Center, emergency room physicians or hospital staff will talk to them about their addictions and resources available to help them, said Richard P. Sullivan, who heads the ER.

"You can use this time to your advantage to try to get them out of the lifestyle," Dr. Sullivan said.

"You try to explain to them, 'Technically you were dead or near death. You don't know when this is going to happen again and the next time you might not be so lucky.' "

In about one-fourth of the cases, the message takes and the addict gets connected with a treatment center.

But most addicts simply wait out the hour and then seek another fix, he said.

Like other ER physicians, he's seeing more heroin and opioid overdoses than he's ever seen since he started in emergency medicine in 1994. And, he noted, medical literature indicates that only half of those who overdose seek medical assistance, meaning medics and emergency rooms are seeing only a small percentage of users.

The regional problem is part of a national one. According to the Drug Abuse Warning Network, ER visits involving heroin jumped from 187,493 in 2005 to 213,118 in 2009, the latest year for which data is available.

"We've always had a baseline community of opiate users in Pittsburgh, but it seems to have exploded in the past decade," Dr. Sullivan said.

"We see [overdose patients] who live in multimillion-dollar houses and those who live in Section 8 housing and everyone in between," he said. The youngest patients are in high school, the oldest are over 65.

"We have senior citizens using heroin. I don't know how else to put it," he said.

"[Heroin addicts] are in a world of trouble and they end up on my doorstep and I'm going to try to help them. The challenges they face trying to recover from this is amazing. They are estranged from their families because they are stealing from them to support their addiction."

Some sell their bodies for bags of heroin, he said. Some come to the ER with abscesses on their arms, sometimes because they nodded off while shooting up and broke off a syringe tip that remains imbedded under their skin.

Surprisingly, some hold down jobs. "How can you work as an attorney or a physician and work around [the addiction]?" Dr. Sullivan said. "They manage to juggle it for a couple months before the wheels come off the car and it crashes horribly."

Even with all of that, Dr. Sullivan said, his message is one of hope.

"You can get lives back on track. This is not a death sentence. There are a lot of success stories out there. No matter how far down you are -- I've seen street prostitutes get their lives together -- you can do it."

But that doesn't always happen.

"There is no more humbling thing than walking into a room and telling a parent their child is dead and nothing worse than for something as stupid as this. It is beyond humbling, it is beyond depressing, it is something you never, ever forget. There is that aspect to it that is horrifying," Dr. Sullivan said.

 

Drug moves into working class

Many of the unlucky ones beyond the help of breathing bags and Narcan end up at the Allegheny County Medical Examiner's office.

Kinetic yet focused, Karl E. Williams, the county's medical examiner, slides his chair from one computer to another in his Strip District office. He glances at statistics and shakes his head.

The common misconception, he said, is that homicides make up most of the cases his office investigates. In actuality, natural deaths take the top spot.

Second highest are overdoses, which in recent years have averaged more than 200 cases -- or more than twice the annual average of 100 homicides. Heroin was present in more than a third of the overdoses, either alone or in combination with other drugs.

"That's a quarter of my workload," Dr. Williams said of the total overdoses. "People say 'How many homicides you have,' but it's been about the same number for the last 10 years. But the number of overdose cases is increasing steadily nationally and in this jurisdiction. There's a massive problem with overdoses."

Drug overdoses have more than doubled from 15 years ago, when they averaged about 100 annually, he noted. Last year, there were 227 overdose cases; heroin was present in 36 percent of them. Fatal overdoses and the percentage of cases with heroin present thus far in 2011 appear to be on pace with recent years.

He said it's no coincidence that during the same 15-year period, the number of prescriptions has skyrocketed for opioids, which are viewed as gateway drugs for heroin addiction.

The sharp rise in heroin-involved overdose deaths is mostly due to the significant increase of heroin and opioid use in suburban and rural areas, he said. The number of deaths in inner-city areas, where heroin traditionally has been used, has remained relatively stable.

"It's moving out into suburbia; it's moving out into the working class, to people who 10 to 15 years ago you would not have suspected of having a drug problem.

"Think about it; if you're truly addicted to these extraordinary potent drugs, they control your life."

And in an increasing number of cases, end it as well.


Michael A. Fuoco: mfuoco@post-gazette.com or 412-263-1968. First Published October 2, 2011 4:00 AM


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