Over the past year in King County, heroin deaths have increased by 58 percent, other opioid deaths are down, and methamphetamine deaths—traditionally a very white phenomenon in King County—are beginning to migrate into Native American and African American populations.
Those are a few details from the 2014 Drug Abuse Trends report for the King County area, just released by the University of Washington's Alcohol and Drug Abuse Institute (ADAI) and now available online. As a special addendum to this year's report, both the county sheriff and prosecutor urge anyone witnessing an overdose to call 911—Washington has a Good Samaritan law that stipulates, in the words of prosecutor Dan Satterberg, that "neither the overdose victim nor the people trying to help the victim will find themselves in trouble with the law for illegal drug possession." Please take advantage of it.
Both Caleb Banta-Green (of ADAI) and Shilo Murphy (of the user-driven People's Harm Reduction Alliance) suspect that the rise in local heroin deaths is related to Washington's 2012 laws restricting access to prescription opiates, leading more users to transition toward heroin. (That 2012 law change formalized a process that began back in 2007 with new state guidelines about prescribing opioids.)
"We've had several years of not prescribing [as much], and we're several years away from people being able to regularly buy oxy[codone] on the street," Murphy says. "Anyone who could prolong their pill use has done that and run out of sources... so people transferred off of every opiate they could transfer off of and onto heroin."
Banta-Green points out that the data since 2012 shows "a big increase in deaths among young adults under 30." That is the same population, he says, that's more likely to report that they've come to heroin via prescription opiates: "They're younger users, more naive users, with no tolerance and a higher risk for overdose."
Younger users who overdose tend to show nothing but heroin in the system, he says, while older overdose deaths typically involve more drugs at once—counteracting some current thinking that heroin isn't as risky as was once thought, so long as it isn't combined with alcohol or other drugs. "If you're 50, there's an 80 percent chance there will be other drugs present," he says. "If you're 20, there's only a 50 percent chance."
But Banta-Green also says that heroin deaths have increased across age groups—not just among young and "naive" users. Part of that could be due to a rise in methamphetamine co-use with heroin. ("Methamphetamine speeds up your heart rate," he explains, "creating a greater demand for oxygen and your breathing increases. What do opiates do? Decrease your breathing, making oxygen less present, which kills you.")
The increase in heroin overdose deaths across age lines also suggests that King County is seeing stronger, purer heroin.
"You always hear about purer heroin and I always discount it," Banta-Green says. "But we're seeing more brown powder"—as opposed to the weaker black tar that is usually affiliated with the Northwest—and the unusual increase of overdoses among older, more experienced users. "Is there just more heroin or purer heroin?" he asks. "We don't know, but there's so much use out there, such a big market, you'd think there would be new people coming in to establish themselves with a better, stronger product."
That could result in experienced users accidentally taking much larger doses than they're used to.
"It could be a new heroin distributor still figuring out their method," Banta-Green says. "But to drop 80 percent pure in a place used to 10 percent, for example, would be a recipe for disaster. There's a fine line between having a product people want and a product that kills people."
Murphy says there are rumors about stronger "China white" heroin making the rounds, though Banta-Green says he hasn't seen any evidence of that from crime-lab reports. Banta-Green is also looking for police reports about fentanyl, a powerful synthetic opiate that needle-exchanges were hearing about around 2012, but hasn't seen any of that lately, either. "There is some word about Mexican-produced white powder in nearby regions, but it's not particularly high purity," he says. "It's not the strong, Colombian-type stuff they get on the East Coast."
Both Murphy and Banta-Green say they expect access to naloxone—a drug that can counteract opiate overdoses and, they stress, should be in every user's toolkit—to have improved, but county needle exchanges are conducting their surveys right now so data is not yet available. Naloxone, like the Good Samaritan law, is not grounds for trouble with law enforcement.
"If anyone's getting harassed for having naloxone and getting it confiscated, contact the prosecutor and the sheriff," Banta-Green says. "If anyone is doing that, it's not legal and not good for public health."
Murphy, who founded the first chapter of the Urban Survivor's Union—also known as the "users' union"—says the most important way to keep users healthy, and perhaps even take steps toward treatment, is to try and keep them from feeling alienated, ashamed, and alone.
"If you want to stop overdose deaths," Murphy says, "the key is getting rid of the stigma, loving and respecting people who use, supporting them to use with friends, providing them with education, and not shunning them."
This post has been updated since its original publication.