(Part two of a six-part series on the effects of heroin on the Mid-Mon Valley.)

Ask Dr. Neil A. Capretto why there is a heroin epidemic and he can pretty much talk all night.

“I give three-hour lectures on it,” Capretto said. “The heroin problem in western Pennsylvania is more intense than ever in our lives.

“More people are addicted to heroin, more people are selling it and more people are dying from it. More families are devastated by it.”

Capretto is medical director for Gateway Medical, a private, nonprofit addiction treatment center.

The largest provider in western Pennsylvania, Gateway has 20 locations in western Pennsylvania and eastern Ohio. The agency was founded by the Sisters of St. Francis in 1972.

“It's the perfect storm — tied into a dramatic rise in prescription drugs,” said Capretto, who has been with Gateway for 26 years. “Ninety-five percent of heroin users started with prescription drugs.”

That storm began in the late 1990s, with a change of philosophy in the medical field that focused on pain relief and treated addiction as a nonissue, Capretto said.

The drug that changed the landscape was Oxycontin. Hitting the market in the late 1990s, it is an extremely strong narcotic: One 80 mg Oxycontin pill is equal to 16 tablets of Percocet, another common prescription painkiller.

“They were meant to be swallowed and time released over 12 hours,” Capretto said of Oxycontin pills. “But people on the street discovered if you crushed it, you got it immediately.

“I saw thousands of people in late 1990s and early 2000s. We were flooded with Oxycontin.”

Western Pennsylvania was the hub of the Oxycontin-use demographic – an older, blue-collar population that had a great need for pain medication.

The public was misled into believing the drug was nonaddictive, Capretto contends.

In 2007, Purdue Pharma pleaded guilty to one felony count of fraudulently misbranding Oxycontin, suggesting it was less addictive and less abused than other painkillers. The company paid a fine of more than $634 million – after making billions on sales of Oxycontin during the previous decade.

Oxycontin eventually hit the streets, Capretto said.

“It spread like an infectious disease,” he said. “We had thousands of people addicted. People were operating pill mills and writing bogus scripts.”

Heroin is an opiate related to morphine. It was developed in the late 19th century as a cough medicine. Within 15 years, it was taken off the market.

Heroin use picked up in the early 1980s. However, HIV awareness by the end of that decade caused heroin use to decline, Capretto said. In that time, people who shared hypodermic needles to inject heroin were in danger of contracting HIV, the virus that leads to AIDS.

The new drug in late 1980s and early 1990s was crack cocaine, and it was especially popular in the northeastern United States. It is a crystal form of cocaine. Crack cocaine is heated and the fumes inhaled, and it is stronger than powder cocaine.

Back on the horse

Heroin — often called “horse” in the 1960s and 1970s — returned in a big way before the 1990s ended.

The demand on the street for heroin initially was a matter of economics.

One Oxycontin pill costs $50 to $80, and addicts routinely take five to six pills a day. In contrast, a dose of heroin — sold in small, plastic “stamp bags” — generally costs $7 to $10.

If an addict runs out of pills, he or she can go through painful opioid withdrawal, known as street sick.

“What came on the scene was a new heroin that gave the same high for one-fifth the daily cost,” Capretto said.

“If they make heroin over 50 percent pure, they don't have to use needles; they can snort it. I saw this develop year by year.”

The road back

The road to heroin-addiction recovery is long, Capretto said.

“You can definitely help a person,” he said. “It takes time and effort, but it can be done. This is a chronic disease. It's not like you have the flu or go into rehab for a week or two.”

The good news is that the heroin problem is being recognized, prompting grassroots efforts to eradicate it, Capretto said. The bad news is that there are no easy solutions.

“We're definitely slowing it down, but there is a huge problem,” he said. “The heroin problem will probably get worse before it gets better.”

Heroin is predominant in the demographic that comprises people ages 18 to 28.

“But we're seeing people in their 40s, 50s, 60s for the first time because they got hooked on pain medicines,” Capretto said. “If someone knows you were in the hospital or had a family member in hospice, they get approached: ‘What did you take? Tell your doctor you need a stronger prescription.'”

Capretto said addicts are desperate. Some of his patients have admitted to going to real estate open-house events to check medicine cabinets for pills. They'll offer estimates for house cleaning as a means to access homes in hopes of stealing pills, he added.

“There's a lot more education of doctors, and that's why there's been some improvement,” Capretto said. “These prescription pills aren't coming from Mexico or Columbia. It's coming from our doctors.”

Cheryl Andrews is executive director of the nonprofit Washington Drug and Alcohol Commission Inc. The agency serves uninsured or underinsured drug- and alcohol-addicted Washington County residents.

It provides drug and alcohol intervention, prevention, screening, assessment and case management services, as well as treatment referrals.

Asked if heroin is an epidemic, Andrews bluntly replied, “yes.”

“Historically, alcohol is the drug of choice among people seeking our services,” Andrews said.

Two years ago, prescription drugs and heroin surpassed alcohol, she added.

“Last year, heroin by itself superseded alcohol use as the number one drug of choice and our number one among people seeking help.”

Battling addiction is a two-pronged problem:

• It is highly addictive.

• Finite financial resources exist for treatment services.

“It is problematic because these people need long-term treatment — three to nine months to recover,” Andrews said. “The way the system is working now, we're only giving them a small amount of what they need for recovery.

“Heroin recovery requires a lot of behavioral changes that have to occur. When we can only send someone to treatment for two weeks, the fog hasn't even cleared.”

Success is hard to track because many recovering addicts are transient, Andrews said.

“What we're trying to do is introduce a case management system, so that when we send them for treatment, we can connect with them in recovery and support them back here when they are released from treatment,” Andrews said.

“(Right now) the only way to know if they relapsed is if they come back through the system. But they may be using and not seeking treatment, may have died or gotten new insurance.”

Recovery is still an uphill battle, Andrews added.

“You're facing a situation you haven't faced in a long time. Maybe you haven't been clean in a long time,” Andrews said. “We try to help them deal with the stress that might cause them to use again.”

Chris Buckley is a staff writer for Trib Total Media. He can be reached at cbuckley@tribweb.com or 724-684-2642.

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