Heroin surges as Kentucky cracks down on pain pills

Four-year-old Ella Warren laid her head on her father's cold gravestone — just as she once would on his shoulder.

"Daddy, I love you," the little towheaded girl said as she touched the smooth granite.

It was a warm, clear evening in August 2013, and Ella and her mother, Katie Warren, were joined by a small group of friends at the neatly trimmed Mount Washington cemetery plot to place flowers and release balloons — marking a year since Ella's father, Jon Paul Jolly of Crestwood, died after overdosing on heroin.

Jolly's death is part of a skyrocketing heroin epidemic devastating families across Kentucky — fueled by a state crackdown on prescription pill abuse that has addicts turning to the illegal street drug to find the same blissful high. Heroin is cheap and potent; a $25 bundle gives the same high as an $80 OxyContin pill.

"Once you're an addict, you're more likely to use any drug that's easily available to you," said Jennifer Hancock, chief operating officer at Volunteers of America of Kentucky, which provides drug treatment. "I wish I could say there is an end in sight. But I'm worried what we're seeing is just the beginning."

Kentucky's heroin surge reflects a national trend. The U.S. Centers for Disease Control and Prevention reports a 55 percent increase in heroin-related overdose deaths from 2000 to 2010. And as in Kentucky, four national studies show heroin users first abused prescription narcotics.

Still, state and federal officials don't believe crackdowns on prescription drug abuse are solely responsible for the rise in heroin — and they say they have no intention of curbing their battle against pill abuse.

Kentucky Attorney General Jack Conway said the state's pill crackdown "played some role but it's not the whole story."

"It's logical they would turn to heroin. Both are opiate painkillers," Conway said. "I would not back down one iota on the prescription drug crackdown. But sometimes, it feels like a game of Whac-a-Mole. You get one drug under control and another pops up."

Gil Kerlikowske, former director of the Office of National Drug Control Policy, said economics plays a huge role in fueling America's heroin addiction; addicts see the illegal drug as a much better deal, as pills get scarcer and more expensive.

Conway said Kentucky is committed to reducing the spread of heroin through public education, law enforcement, legislation and greater access to treatment, which is woefully limited now.

But a bipartisan heroin bill died in the General Assembly this year, and at this point, some doctors, addiction professionals and others say Kentucky seems to be losing the fight.

Dr. Eric Fulcher, an emergency room doctor at Sts. Mary and Elizabeth Hospital in Louisville, said doctors and nurses there deal with more than one heroin overdose a day, with doctors often running out to cars to administer naloxone, a rescue drug that can reverse the effects of an overdose if given quickly enough.

"Some days it really feels like we're running a drive-through OD clinic," Fulcher said

From painkillers to heroin

Katie Warren of Louisville said she and Jolly slid into addiction the way so many Kentuckians have — turning first to pills.

She and her boyfriend got hooked on the powerful narcotic painkillers OxyContin and Opana, she said, which they bought from friends and acquaintances. Soon, their lives revolved around the drugs.

"That's where my mind was 90 percent of the time," said Warren, who temporarily lost custody of her daughter. "I missed a lot of Ella growing up."

But prescription drugs eventually got too expensive, costing $150 on the street for a 40-milligram Opana pill.

Warren, who attended Jefferson Community and Technical College and worked as a restaurant server, said she sometimes could find them for $95 and sell them to others for $150. But even then, she blew through the money quickly.

Heroin was much cheaper — and more available.

"It was everywhere," she said.

Other recovering addicts say much the same.

Ashly Chappell, who got treatment through Volunteers of America, said she and other addicts used to buy heroin from the dealers hanging out in Louisville's West End between 23rd and 41st streets.

"It's grown faster than anything I've ever done," she said. "Heroin now is like crack was in the '90s."

Law enforcement officials said heroin first took root in Northern Kentucky, coming south through Chicago and Detroit to Cincinnati, before moving on to Louisville.

More recently, it has spread to Eastern Kentucky, the area hardest hit by prescription pills.

Dan Smoot, chief executive officer of the Eastern Kentucky anti-drug organization Operation UNITE, said while pills are still the biggest problem there, about six in 10 calls to a treatment line are from addicts whose drug use includes heroin.

And while the problem is much less pronounced in Western Kentucky, Dr. Tracey Corey, Kentucky's chief medical examiner, said it is increasing statewide and "spreading out."

U.S. Sen. Mitch McConnell, R-Kentucky, told a Senate hearing last week "the problem of heroin abuse is spreading like a cancer" across the state.

Cracking down on addiction

It's no coincidence that heroin's dramatic rise coincides with efforts by drug companies and federal and state agencies to curb prescription drug abuse.

In 2010, the U.S. Food and Drug Administration approved a new abuse-resistant formula that if dissolved, turns pills into a gummy substance that can't be injected. Purdue Pharma stopped shipping crushable OxyContin to pharmacies, and the makers of Opana followed suit.

In 2012, the Kentucky General Assembly passed House Bill 1, which increased oversight of pain-management clinics, cracked down on pill-pushing doctors and required prescribers to use an electronic prescription drug-monitoring system called KASPER. Supporters argue the law has curbed pill abuse, but critics say it's also limited legitimate patients' access to painkillers and driven some addicts to heroin.

"The intent is fine," Fulcher, the emergency room doctor, said. ""But I think the medical board has made (prescribing painkillers) so cumbersome and confusing it has led to this."

Peggy and Thomas Simpson said their son, Ronnie, became addicted to prescription drugs when doctors prescribed painkillers after his back surgery. Peggy remembers him telling her, "I can't do without them."

At some point — his parents don't know when — he turned to heroin. Last April, his parents came home one afternoon and found him dead on his bed. An autopsy blamed acute heroin intoxication.

"It was just unbelievable," Thomas Simpson said.

Jolly's drug abuse led to a similar end.

Though he and Warren sought help — Warren through Volunteers of America and Jolly through Jefferson Alcohol and Drug Abuse Center — only Warren was able to kick her addiction.

Jolly was found in his Ford Focus in the parking lot of an auto parts store off Dixie Highway in August 2012, dead of an overdose at 24.

At his funeral, Warren could hardly bring herself to take Ella to Jolly's casket.

"She said 'Daddy's sleeping.' She just wanted to keep waking him up."

'Cadillac of opiates'

Experts say heroin is especially deadly because it is both highly addictive and unpredictable.

The drug is a depressant, synthesized from morphine, a naturally occurring substance extracted from the opium poppy. Heroin can be a white or brown powder or a black, sticky tar that can be sniffed, snorted, smoked or injected.

It is converted into morphine when it enters the brain, where it binds to opioid receptors and produces a rush of euphoria.

"If you're an opiate addict, heroin is the Cadillac of opiates to do," said Jean Henry, director of addictions and outpatient services for Our Lady of Peace, which provides substance abuse treatment in Louisville.

Chappell, 29, said her drug use began with alcohol at age 13, then prescription pills and crystal methamphetamine. Finally she discovered heroin — which she abused for six years, even while pregnant with her son in 2012.

"Heroin took over everything. It was my miracle drug," Chappell said. "When I started doing heroin, I unleashed a beast."

Recovering addict Patrick Wilhem said he experienced something similar after a girlfriend he met while seeking treatment for an OxyContin addiction suggested trying heroin.

"It was much more intense and quicker," he said. "The phenomenon of craving is so strong."

Addicts who try to stop using the drug suffer fierce withdrawal — cravings, restlessness, cold flashes, even muscle and bone pain — making it difficult to treat. Even with cognitive behavioral therapy, opiate replacement therapy, 12-step recovery programs and other treatments, patients frequently relapse.

Heroin is also dangerous because there's no way to know exactly what you're buying. National experts say street heroin may be cut with other drugs or substances such as sugar, starch, quinine or even poisons such as strychnine. Some states have recently reported heroin laced with the narcotic painkiller fentanyl.

"Heroin is much more potent," Hancock said. "There's so much risk involved for overdose."

Use too much and it can shut down the respiratory system.

"Basically," Fulcher said, "the body is told to stop breathing."

Uphill battle

Kentucky officials say they are taking steps to curb the heroin epidemic, partly through increased treatment.

"We know that addiction is a terrible disease, and better access to treatment will help these individuals and families who are suffering," said Gov. Steve Beshear. "New standards for health insurance require coverage for behavioral health needs, including drug abuse treatment, which will be a big help in addressing this problem."

But treatment can be hard to find. A 2012 Courier-Journal investigation found that Kentucky's treatment options are limited, especially for hard-core addicts in need of the most intense care. Less than 15 percent of treatment and recovery sites offer 24-hour residential care; most are for outpatients only.

Late last year, Conway joined state Sen. Katie Stine, R-Southgate, and Rep. John Tilley, D-Hopkinsville, to support a bipartisan bill in the General Assembly that proposed using money saved through a recent penal reform law to fund improvements in treatment, education and law enforcement.

It would have cleared the way for dealers to be charged with homicide when the sale of some Schedule 1 controlled substances results in an overdose death — a change criticized by some lawyers' groups as one that would alter fundamental standards in criminal defense law — increased penalties for high-volume drug traffickers and raised funding for drug treatment. But the bill died for lack of a vote, and Beshear has said a special session is unlikely.

Even so, Conway said law enforcement agencies across the state are "beginning to make a concerted effort" against heroin by, for example, creating task forces to fight the drug. Louisville Metro Police officials said they don't have a specific heroin task force but do have 50 sworn officers in narcotics units. They said detectives educate and train police colleagues on heroin and any other drugs on the rise.

"More can certainly be done here," said Conway, who recently announced he is running for governor in 2015. "We can always do more."

Letting go

Warren said she wants to help other Kentuckians avoid the pain heroin has brought to her family.

Since Jolly's death, she has been speaking to groups about its dangers through Volunteers of America. She has also been staying clean with the help of family members and 12-step recovery programs. She waits tables, attends classes at Jefferson Community and Technical College and is raising her two daughters.

"I feel like that's my promise to (Jolly.) I'm Ella's mom, and I'm all she has," said Warren, who also has a younger child. "Everything's just clear now. Even though every day is still a struggle dealing with his death, I know drinking and drugging isn't going to do anything but make it worse."

Jolly's friends and family said they will remember him as a hard worker with an outgoing nature who loved taking his daughter out for Polar Pops and Cokes.

One of his best friends, Jeremy Drury, recalled riding bikes with Jolly as young boys, then moving on to four-wheelers and finally to an old Mustang that they worked on together. When Jolly died, Drury said, he had to sell the Mustang because he couldn't look at it anymore.

Drury joined Warren at Jolly's graveside on the first anniversary of his death. Each held a balloon. Ella's was decorated with a hand-drawn heart.

"This is going to go up in the sky and Daddy's going to get it, OK?" Warren said, her voice breaking.

Ella wiped her mother's tears, then watched from her mother's arms as the rainbow-colored balloons floated higher and higher.

"Bye," Ella said, pointing at the evening sky.

Reporter Laura Ungar can be reached at (502) 582-7190. Follow her on Twitter at @lauraungarcj.