On Tuesday, much of the weight of the federal and state law enforcement apparatus in north Alabama will be focused on one generations-old scourge: heroin.
US Attorney Joyce Vance of the Northern District of Alabama, along with colleagues from medicine, education and elsewhere in the community will convene a summit, held at the University of Alabama at Birmingham, to map out a comprehensive strategy for combating a drug some thought was a relic of the past, but which has reappeared lately with a deadlier bite than many imagine.
Vance related a story last week that helps illustrate the problem. At a meeting in another state, an employee of the U.S. Attorney’s office “took me aside and told me the story about her niece who had died from a heroin overdose in March in Trussville,” Vance said. “And I just can’t tell you how many times you hear about people’s kids or you read these stories. It’s just too constant of an occurrence. With crack, I don’t remember people dying every week. With meth, I don’t remember people dying every week.”
Heroin deaths are increasing across north Alabama, cutting through social and economic lines, challenging expectations tied to class and demographics and forcing people to look past the stigma and acknowledge a problem growing throughout the community.
Crack and meth have taken their respective tolls, but heroin is a horse of another color. “Heroin is more dangerous in terms of immediate overdose death,” Vance said. “Just that raw overdose death rate is so striking. This year, in the city of Birmingham to date – [there have been] more heroin overdose deaths than violent gun deaths. … Heroin is a unique problem.”
The “Pills to Needles: The Pathway to Rising Heroin Deaths” call to action summit is being held Tuesday at the UAB National Alumni House, 1301 10th Ave. South.
Vance explained before the summit that this event, which brings together 250 professionals from law enforcement, medicine and the community, is an outgrowth both of the U.S. Attorney’s long-term drug strategy and the way the trafficking landscape has changed.
Primarily, she said, drug prosecution is carried out through OCDETF, the Organized Crime and Drug Trafficking Enforcement arm of the U.S. Attorney’s office. “We use OCDETF to attack organizations that move drugs both nationally and transnationally, the idea being to dismantle those organizations, to take away their resources, and of course everyone has a piece of that, right? If you’re sitting in the middle of Idaho, well, the piece you have might be a little bit different than the piece they have down in Miami. But we try to dismantle those networks where they operate,” Vance said.
Using that strategy, law enforcement went after the “absolutely horrible problem” of crack, and then methamphetamine abuse, and then found itself shifting gears to a problem whose significance caught many unawares.
“It was really interesting,” Vance said. “A couple of years – I was still in our appellate division – I started hearing about a pill case – a prescription drug case. And I thought, ‘Why are we devoting our resources to prescription drugs? This is crazy.’ … But it turned out that prescription drug abuse had become an enormous problem. And that many people had shifted to prescription opiates and that there were organizations that were trafficking those drugs and they, in fact, became a lead [Drug Enforcement Agency] priority.”
Still, prescription drugs were only the gateway to an even more surprising shift in the war on drugs.
“Heroin wasn’t really on anybody’s radar screen, right? It was a ’60s drug. It was gone,” Vance said. “Well, all drugs are cyclical, and heroin’s issue over time is that it periodically raises its head. And in many ways it is a logical shift out of those prescription drugs that many of us first didn’t understand why we were doing.
“But now, believe me, everybody is full-on in favor of enforcement in that area and that, I think, the science suggests is what has led to this recent resurgence of heroin. Similar high to the opiate drugs — in many ways it’s described as a better high. Much less expensive high. And we know that the organizations that move drugs have in many places and in many ways have shifted their marketing strategies on to heroin.”
Law enforcement became aware of heroin’s return when people began dying from it, Vance said.
“What we saw was this sudden up-crop of overdose deaths,” she said. “But it wasn’t like 50 in Birmingham in one month. It was two here, and three here, and one over in Tuscaloosa and a couple in Shelby County. And some of the sheriffs started mentioning that they were seeing overdose deaths.
“And so we got everybody together in a room in 2012 and started talking about it, and when you added up all of those different incidences you realized that across the three-county area — Tuscaloosa, Shelby and Jefferson — there was no doubt that heroin was back.”
Spreading across a community
Among the law enforcement agents in that 2012 meeting were some who already had personal anecdotes about heroin deaths. “People in the room had family members, had friends who had overdosed on heroin,” Vance said. “There was a lot of talk about how the use of cell phones and technology – that’s really made it a lot easier for people who sell drugs illegally to do their work.”
Initially, agencies went after the organizations dealing the heroin, much as they had for crack and meth. “We had a couple of OCDETFs during that time frame that were picking up heroin trafficking. And then we also did a heroin initiative to try and get a sense of where in this community…who is selling heroin? Where is it being sold? Let’s see what we can do to divert the supply of heroin by going out and doing a whole lot of arrests on one day, like we did, to give ourselves some breathing space to try to assess the problem and try to figure out how to deal with it.”
One thing authorities learned is that heroin use is not isolated to one socioeconomic group. Recounting a conversation with Birmingham Police Chief A.C. Roper, Vance said that heroin “cuts across all demographics. It can be rich or poor, white, black,” Vance said. “We’ve had university kids who overdosed. I think maybe some people think heroin is an inner city problem. I think our experience here is, it’s an everywhere problem. It’s as likely to be in Mountain Brook. … Part of the problem with heroin, right, is people want to think, ‘It’s not my problem. It’s happening in a different community.’ Our sense is it’s happening everywhere.”
And it’s not just a problem in Alabama, based on conversations Vance has had with colleagues across the country. “It’s fair to say that if you live in an area where you’re not seeing heroin right now, you’re going to be seeing it soon. Because last year, when I talked to a lot of my sheriffs in North Alabama, they said, ‘No, we don’t have a heroin problem. We’re not going to ever have a heroin problem. We’re not that kind of a county.’ We had five overdose deaths in Florence, Alabama last month.”
A significant part of the problem is that the quality of the heroin has improved – improved so much, in fact, that it’s killing at an unexpected rate. “When we did the heroin initiative in Birmingham, DEA was just informally sampling the heroin for purity. Not a scientific method, right, but I think they took 100-plus recoveries of heroin and they, maybe, sampled 20 to 30 of those. They got heroin that was as high as 95-98 percent pure. And so that’s your needle-in-the-arm death. It’s too strong for the body to withstand.”
Compare that to the days when heroin routinely tested out as “20, 30, maybe low 40s,” and it’s not difficult to understand how this new, purer version is catching users off-guard. That too is one of the differences between heroin and crack. “Crack users can assess its purity and with heroin, they cannot,” Vance said.
And despite efforts to publicize the danger of this new, even more dangerous heroin, Vance said she’s not sure if users know what they’re putting into their arms.
The summit this week is designed to bring medical professionals, lawyers and law enforcement agencies together to tackle the problem of heroin in north Alabama. The two lead doctors are Max Michael, the dean of the UAB School of Public Health at UAB, and Mark Wilson, head of the Jefferson County Health Department.
A beginning – in the medicine cabinet
The summit brings to bear expertise and data from several people in the community, including J.W. Carpenter from the Birmingham Education Foundation, Ann Florie from Leadership Birmingham, the Addiction Prevention Coalition, the Federal Bureau of Investigation, the DEA, Birmingham Police and sheriff’s departments from Jefferson, Shelby and Tuscaloosa Counties. “Really, the last time I saw cooperation like this was when we had a terrorism situation,” Vance said. The response to the call to convene over the heroin issue outstripped expectations.
“We’re at a point where we’re turning people away,” Vance said. But for those who don’t make it to the summit, “we’re telling people that there’s a lot of work to be done after the summit.
“Our goal here is to educate different segments of the community — educators, parents, medical community and emergency responders and just interested community members. And then, to begin work on a community action plan…a very bare-bones document that says, ‘to deal with the addiction problem, law enforcement has to do its job and it has to do it well and it probably has to innovate. … But it’s not a problem you can arrest your way out of.’
“What there has to be is a community piece. A medical community with best practices so that they can cut the cycle of the pill addiction leading to heroin abuse. … It is clear that the path to heroin addiction is through prescription drugs. So that means there’s a lot of work we can do in the community.”
Attacking the problem at its roots, then, means preventing teenagers and others from having such easy access to prescription drugs, including opioids, in the first place. “Biggest source for your teenagers to get access to the prescription drugs that they might abuse is their grandparents’ medicine cabinets,” Vance said. “We have to focus as a community on drug take-backs. DEA sponsors these multiple times a year. We always get tons of prescription drugs dropped off, but we can do more. As a community, we can establish permanent drug take-back sites.”
Alabama, she said, is one of the states where a lot of prescription drugs can be found. She cited the example of the opioid pain killer OxyContin. The second highest number of prescriptions for OxyContin per capita are written in this state, she said. “Alabama’s got a population of 4.2 million. Last year in excess of 15 million prescriptions were written for pain killers. So we’ve got a prescription drug cycle that we have to deal with, and that’s why we need a community action strategy that involves the medical community, that involves parents and educators.”
The job of educating stakeholders in the community has already begun, but the facts of heroin’s resurgence have been hard for some to ignore. Vance spoke of a district judge who had two people being dealt with in her drug court who died from heroin within a 10-day period. And some schools are living the issue as well she said.
One school superintendent, invited to the summit, wrote her in an email, “I wish I could tell you that heroin wasn’t a problem for me. But it is. … We need support, we need to learn about this, we need to do more.”
“I think a lot of people in this community are at that same point,” Vance said. “So I think our timing is fortuitously very good.”
After the summit, Vance hopes to reconvene in 30 days or so to flesh out the action plan. Meanwhile, heroin arrests and prosecutions continue to demonstrate that the drug is a law enforcement priority.
“Selling heroin in this district right now is a bad bet, because law enforcement is looking, law enforcement is intent on finding dealers and intent on cutting that supply off,” Vance said.
Under federal guidelines, offenders can get a wide range of sentences depending on a variety of factors. Being convicted of selling heroin where a death occurred can result in a minimum 20-year sentence.
“I think it’s important for people who are thinking about selling heroin in my district to understand there’s no parole from the federal system,” the U.S. Attorney said. “If you get five years, you’re essentially going to serve five years.”