A year ago, patients with heroin addiction were a rare sight at Bradford Health Services in Chattanooga — usually no more than one a week, if that.
But last fall, clinical coordinator Monretta Vega started noticing a jump in the numbers. In one week, the clinic treated five heroin users. By the springtime, it was seeing anywhere from 10 to 15.
The situation at Bradford mirrors a report released this week from the U.S. Centers for Disease Control and Prevention that shows a resurgence of heroin use across all demographics: sex, age and income levels.
"We have been seeing so many more people needing help with heroin, including adolescents," Vega said. "The prescription opiate pills have doubled in price. Heroin is so much cheaper."
WHAT CAN STATES DO?
The CDC has said that states play a central role in curbing the heroin addiction, and gives the following recommendations for responding to it. Address the strongest risk factor for heroin addiction: addiction to prescription opioid painkillers.
Increase access to substance abuse treatment services, including medication-assisted treatment for opioid addiction.
Expand access to naloxone to reduce opioid overdose deaths.
Give people access to integrated prevention services, such as sterile needle exchanges, as allowed by local policy.
Target communities where drug addiction is common and provide special assistance.
At a glance
› Heroin use more than doubled among young adults ages 18-25 in the past decade.
› More than 90 percent of people who used heroin also used at least one other drug.
› 45 percent of people who used heroin were also addicted to prescription opioid painkillers.
› Some of the greatest increases occurred in demographic groups that have historically low rates of heroin use: Women, those with higher incomes, and those with private insurance.
Source: U.S. Centers for Disease Control and Prevention
HEROIN ARRESTS, SEIZURES
› Heroin-related arrests in Tennessee soared to a 352 percent increase from 2009 to 2014, the TBI reports.
› Heroin seizures rose from 177 in 2010 to 888 in 2014.
› In Hamilton County, heroin seizures were up from two in 2010 to 70 in 2014, TBI data shows.
The rate of heroin-related overdose deaths has nearly quadrupled between 2002 and 2013, and the number of heroin-related arrests has soared. Some of the greatest increases occurred among groups that have historically low rates of heroin use: women, those with higher incomes and those with private insurance, the CDC said.
The heroin spike is closely related to the nation's prescription drug epidemic. And Tennessee, which has some of the highest per capita prescription and overdose rates in the nation, could be primed for its own heroin spike, health officials say.
The state's crackdown on prescription drug abuse through new laws and a prescription monitoring service mean drugs like oxycodone and hydrocodone are more difficult to obtain. But heroin is cheaper and more accessible than ever thanks to foreign drug cartels that have capitalized on the change, law enforcement officials say.
In Tennessee, the number of people being treated for heroin addiction at state-funded facilities, like CADAS in Chattanooga, grew from 322 in 2011 to 802 in 2014.
Doug Varney, commissioner of the state's Department of Mental Health and Substance Abuse Services, said he is troubled by the trend.
"This growth of heroin usage is not surprising, but I had hoped it would not be as impactful as it has been," Varney said in a telephone interview Wednesday. He said he plans to convene a heroin task force this summer.
"This is a natural extension of the work we started — dealing with the full scope of addiction."
Officials at CADAS say they have seen an uptick in heroin users and are expecting to see more.
"It's just interesting to see how some of these efforts, like prescribing guidelines and monitoring systems, [have] a domino effect that brings these other drugs back to the top," said Debbie Loudermilk, director of outpatient services.
"We do have our eyes on it, and we are concerned."
Both Vega and Loudermilk say more and more patients they treat locally for heroin addiction match the growing demographics identified in the new CDC report: young, white and middle-class.
"You see people with great family backgrounds, high incomes, using it," said Vega, adding that the center has treated everyone from bank workers to mechanics to nurses.
Varney and other Tennessee addiction specialists say that even though they don't expect the majority of people addicted to prescription drugs to turn to heroin, the ones who do present serious new health and crime-related questions.
Most users inject the drug, which opens up a slew of public health concerns. Not only does intravenous use mean quicker overdoses, it means a rise in diseases that spread through needle sharing, like hepatitis C or HIV.
Already, state officials have seen a rise in hepatitis C, Varney said.
And the source of the drugs is more dangerous. Whereas about 70 percent of prescription drug abusers in Tennessee have gotten their pills from a family member, the heroin market is tied to a more criminal element.
"What happens when this new demographic starts interacting with gangs? They have no frame of reference for what they're getting into," Varney said.
The state's top law enforcement officials also are worried about the heroin problem over the next three to four years. In December budget hearings, Tennessee Bureau of Investigation Director Mark Gwyn told Gov. Bill Haslam that "heroin will be our next meth."
Chattanooga's location along a heroin pipeline — Interstate 75 — could make it a prime drop-off point from larger cities like Atlanta and Nashville, law enforcement officials said.
Gywn said the Mexican cartels that control the heroin trade have cut prices and have targeted areas with high rates of opiate addiction to sell the "black tar" version of the drug.
"It's kind of another consequence of having a pill problem in the state," Gwyn said at the time. "It's an economic thing. Why pay $40, $50 for a hydrocodone tablet when you can pay $10, $15 for a bag of heroin?"
In the CDC report, officials said that state leaders play "a central role" in addressing the growing issue. Varney said he hopes the task force will be able to create a plan that battles the problem on multiple fronts.
In the meantime, he is praising two bills passed during Tennessee's last legislative session that address overdose deaths. The first allows first responders to carry the lifesaving drug, nalaxone, which reverses overdoses.
"This heroin is much more potent than any we've seen in the state before, and we have novices using it," said Varney. "If a first responder can give them the nalaxone, it can keep them from dying."
The other bill creates a good Samaritan provision to allow people to call and report an overdose without fear of being criminally charged. Such laws prevent people who are overdosing from being abandoned in crisis.
Contact staff writer Kate Belz at firstname.lastname@example.org or 423-757-6673.