In Lancaster, Ohio, Holly Yates started using painkillers in the ninth grade, at parties and hanging out with friends. The pills were everywhere, easy to get and cheap. By the time she was 18, she was abusing oxycodone, Percocet and other pills every day. 

Then they stopped being enough. 

“My cousin was into heroin and I started hanging out with her,” said Yates, a hazel-eyed 20-year-old. “She told me about it, and I was like, ‘I want to try it.’ The first time that I shot it up, it was like, ‘Where has this been all my life?’”

Experts say Yates and others in this town of about 38,000 southeast of Columbus are on the leading edge of a frightening new drug abuse trend – one that is ironically being fueled by a national crackdown on prescription painkillers. While new regulations and law enforcement efforts have significantly reduced the supply of these drugs, they say, those efforts have inadvertently driven many users to another type of opiate that is cheap, powerful and perhaps even more destructive – heroin.

“It’s an epidemic,” said Dr. Joe Gay, director of the regional addiction and mental health clinic Health Recovery Services, who has studied patterns of drug use in the state.

A flood of cheap heroin from Mexico, which is now one of the leading sources of the drug to the United States, is one reason for the return of the scourge. According to the Justice Department, the drug is showing up in new areas, including upscale suburban towns where heroin was once rare. 

In Illinois, for example, researchers at Roosevelt University have found a spike in young suburban heroin abusers. Long Island, New York, has in recent years seen a rash of addiction among the young. A spike in heroin use and related crime has Dane County, Wis., reeling. Even states like Washington, where heroin has a longtime presence, have seen a sharp increase among young users. In King County, home to Seattle, nearly a third of those entering treatment for heroin abuse in 2009 were between ages 18 and 29 — a sharp increase from a decade before.

With increased availability has come a spike in the number of visits to emergency room visits for issues related to heroin use, including a 13 percent increase from 2005 through 2009, according to the national Drug Abuse Warning Network. The highest rates of admission were for young adults, 21 to 24 years old.

“Twenty years ago, half of the heroin addicts in treatment lived in two states — New York and California,” said Gay. “(Now, in Ohio) we’re seeing it spread out of the cities, into the suburbs and into the rural areas.”

The demographics of heroin addiction are also shifting, he said.

‘It’s not going away’
Until a few years ago, addicts were overwhelmingly men who lived in urban areas, many of them from racial minorities. An alarming number of those entering treatment programs in Ohio — a good measure of addiction — are young, he said. Most are white. They are from poor rural counties and wealthy suburbs. Many are girls and women.

In Ohio, the new face of heroin addiction could be the girl or boy next door.

“Everybody does it,” Yates said. “It’s just here, and it’s not going away.” 

Sarah Mayer, 27, was an early traveler on the path from dabbling in prescription pills to putting a needle in her arm.

Born and raised in Hilliard, a tree-lined suburb of Columbus, she grew up in what is, by all accounts, a loving home. Her father works at the local bank. Her mother is a nurse.

Derailed plans
In high school, Mayer went to parties and drank occasionally, but she kept her grades up. During her last year in high school, in 2002, she took college classes. After graduation, she started a fully-paid-for nursing program. But her plans were derailed by addiction to oxycodone, an opiate-based painkiller found in many medicine cabinets across the country.

“I really didn’t know what I was getting myself into,” Mayer said. By 2005, she and her boyfriend were taking the pills regularly to get high. But over time, the effects diminished.

One day in early 2006, Sarah and her boyfriend found themselves nearly broke and without the pills they needed. Desperate and sick with withdrawals from the opiates, her boyfriend left the house to try to find pills.

He came back with a bag of powder heroin.

“He knew how I felt about heroin,” Mayer said. “That was the one thing I said I would never do.”

Despite her conviction, within 24 hours, she had snorted it. She would spend another three years chasing that first high. “It was almost like all of the wind was knocked out of my chest, I could barely hold my head anymore,” said Mayer. “It was like my whole body just exhaled.” 

Soon, she began injecting it. It would take her years, and at least six trips to recovery programs, before she successfully got clean in October 2009. She’s now working toward a degree in nursing, and recently made the dean’s list.

The addiction was something the Mayer family never saw coming. 

“There was never a thought that ever entered my mind that I would ever lose a child through addiction,” said Randy Mayer, Sarah’s father. “Watching this thing grab her and not let go, I mean, it was a horrible time.” 

But in Hilliard, where he also grew up, Randy Mayer said he is seeing this happen to others. 

“I’ve met some other families, locally here — they’re dealing with the same kind of situation,” he said. “The fact of the matter is, these towns like this are fertile for this to spread.”

Paul Coleman, director at the Maryhaven clinic near Columbus, where Mayer sought treatment, said about a quarter of the nearly 130 adolescents currently getting treatment there have used opiates —  something he’s never seen in his 22 years at the center.

“A few years ago if you would have asked me how many young patients I would have using opiates I wouldn’t have said 25 percent,” Coleman said. “I would have said none.”

The White House has called prescription drug abuse the nation’s fastest-growing drug problem. The Centers for Disease Control and Prevention has officially dubbed it an epidemic.

‘Crisis’
In Ohio and elsewhere, however, the beast has two heads. Opiate abuse, which includes both prescription painkillers and heroin, has become a “crisis of unparalleled proportions,” according to Ohio’s Department of Alcohol and Drug Addiction Services. In 2001, just eight of Ohio’s 88 counties reported a significant number of patients were entering substance abuse treatment for opiate addiction. By the same measure, 85 of Ohio’s 88 counties reported an opiate problem in 2009.

The state has taken action. In 2006, it implemented a system to track prescriptions to help prevent so called “doctor shopping,” where addicts move from one physician to the next looking for prescriptions. Last year, it also passed a law to help fight “pill mills,” unscrupulous storefront clinics known for readily dispensing prescriptions.

Similar measures have been taken across the nation. Combined with new pill formulations that make the medication harder to crush up to snort or shoot, the efforts have curbed supply and abuse. Experts agree this is a positive step. But in Ohio, the crackdown has had unexpected consequences.

The pills have become expensive, and often hard to obtain. Prescription opiates now sell for anywhere from $30 to $80 dollars a pill. A $10 bag of heroin offers a similar or better high.  Unable to find pills, or afford them, addicts go looking for something else to feed the craving. Heroin is cheap, plentiful and potent.

It is also deadly. In fact, the state saw a record number of heroin-related deaths in 2010, which now account for one in every five overdose deaths in the state. Cuyahoga County, home to Cleveland, recorded 106 heroin-related deaths in 2011 — an increase of nearly 180 percent since 2003, according to the Cuyahoga County Medical Examiner’s Office. In early May, Loraine County, Ohio, saw five fatal overdoses in 10 days due to a batch of highly potent, or badly cut, heroin. Experts worry other counties may soon follow suit, and that those dying might be among what the Ohio Department of Alcohol & Drug Addiction Services reports show is the fastest growing demographic of heroin users — young people between ages 20 and 35.

It’s an addiction that surprises even those who find themselves in its grip.

“If you were to tell me that I was going to use heroin … the same week in which I used it, I probably would have laughed in your face,” said Tej Yaich, a 20-year-old from Pickerington, Ohio. “That’s something that I would never have done.”

For Yaich, who has been sober for more than a year, addiction started at home. His parents had prescriptions sitting unused in the medicine cabinet. Yaich said he was 15 when he first tried them, crushing them up at night so his parents wouldn’t hear the noise. The experiment became a habit. Then the supply started to dry up.

“One day I went to call my guy that was selling to me and he said he didn’t have pills at that time, but he had something equally as good,” said Yaich. “He said, ‘You’ll like it.’”

 What the dealer had was heroin, and he was right. Yaich started by snorting it, then quickly moved on to shooting up. From one bag, he worked himself up to two, then five. At the height of his addiction, he said, he injected up to 25 bags a day.

Yaich’s story is typical of those that Dr. Steven Matson hears from young people coming into his clinic at Nationwide Children’s Hospital in Columbus. Matson, who helped Yaich recover, runs a program there that uses a fairly new medication called buprenorphine, a semi-synthetic opioid that when used correctly helps to curb cravings to assist in recovery.

When Matson started this work three years ago, the young people coming into his clinic were “fringe,” he said. Now they are as often from upscale suburbs of Columbus as from poorer, more rural areas.

“Because of the availability of these drugs now, it is not an usual story that we hear, ‘I went to a party, some friends there were doing heroin, so I shot up,’” he said. “It seems like madness that you would go to a party and never have used anything and then use heroin. But that’s what’s happening with some children.”

Matson’s program also helped Holly Yates recover. She’s been sober since Thanksgiving Day 2010. For more than a year, she’s held a job as a stylist at a local hair salon. She saved up to buy herself a silver Honda Accord. In the back seat are two car seats for her young nephews, who her older brothers now trust her to babysit.

But things can be lonely in Lancaster, where she says nearly everyone her age uses drugs, and many are hooked on heroin.

“It’s just hard being young and staying clean,” Yates said. “I mean this town, it’s just, like, that’s all that’s here.”

“I just want kids my age to know that you don’t have to keep using,” she added. “You can be clean, and you can have a better life.”

By Lisa Riordan Seville and Hannah Rappleye
NBC News

Michael had been snorting OxyContin for five years when a new version of the drug, intended to deter such abuse, hit the market last summer. The reformulated pills are harder to crush, turning instead into a gummy substance that cannot be easily snorted, injected or chewed.

James, 28, of Revere, Mass., at a treatment center in East Boston. He said he started using heroin when OxyContin changed its formula.

Uncrushable Oxycontin

A blow with a hammer deforms, but won’t crush, the new OxyContin. The original formula could be turned into powder easily.

Instructed by his dealer, Mr. Capece, 21, tried microwaving one of the new pills, then sniffing up the burnt remains. Other addicts have tried to defeat the new formula by freezing, baking or soaking the pills in solvents ranging from soda to acetone. Many are ending up frustrated.

“It’s too much work,” said Mr. Capece who entered a rehab program here last month. “It wasn’t anything I enjoyed.”

A powerful narcotic meant for cancer patients and others with searing pain, OxyContin is designed to slowly release its active ingredient, oxycodone, over 12 hours. But after it was introduced in 1996, drug abusers quickly discovered that chewing an OxyContin tablet — or crushing one and snorting the powder, or injecting it with a needle — produced an instant high as powerful as heroin. It has been blamed for waves of addiction that have ravaged certain regions of the country, and has been a factor in many overdose deaths.

Purdue Pharma, the maker of OxyContin, may have succeeded for now in reducing illicit demand for its reformulated drug. But in several dozen interviews over the last few months, drug abuse experts, law enforcement officials and addicts said the reformulation had only driven up interest for other narcotics.

Demand appears especially high for pure oxycodone pills that come in a 30-milligram dose, often called “Perc 30s” or “Roxies” on the street. Opana, a time-release painkiller similar to OxyContin that has been on the market for five years, is showing up increasingly in police reports and has been blamed for a rash of overdose deaths. And heroin use has jumped sharply in many regions, according to rehab centers and the police.

“It’s just a matter of switching,” said John Burke, commander of the drug task force in Warren County, Ohio, and president of the National Association of Drug Diversion Investigators. “If I’m an addict, I’m going to find a drug that works.”

Mr. Burke said abuse of other oxycodone drugs was already growing before OxyContin was reformulated last August, partly because the other drugs are cheaper and because OxyContin had become harder to find on the street. Many doctors had stopped prescribing it because of its stigma and switched to other oxycodone drugs, Mr. Burke said.

Raymond V. Tamasi, president and chief executive of Gosnold on Cape Cod, a treatment center, said he had noticed that addicts switch initially to the Perc 30s.

“But eventually people make that progression from the pills to what appears to be a more economical high, which is heroin,” Mr. Tamasi said.

Prices vary, but 30-milligram oxycodone tablets generally sell on the street for $20 to $30 each, according to addicts and law enforcement officials. The old OxyContin sold for as much as $80 per 80-milligram pill. Several recovering addicts in Massachusetts said an 80-milligram tablet of the reformulated version, called OxyContin OP, costs about $40.

“You don’t make any money selling the OPs,” said James Moore, 28, who said he stopped selling and snorting OxyContin and moved on to heroin after the new version came out last year.

Mr. Moore, who said he used to snort as many as 10 OxyContin pills daily, was arrested in November for selling heroin and now lives at a halfway house in East Boston. Addicts can still get high from swallowing the new OxyContin pills, he said, but most prefer the immediate rush delivered by snorting or injecting the powder.

Outside of OxyContin, which comes in doses as high as 80 milligrams, the 30-milligram dose is the highest available for oxycodone, which is why addicts covet it.

Some addicts are reporting an even more powerful high from Opana, a time-release opiate painkiller whose active ingredient is oxymorphone. In Louisville, Ky., there have been at least 14 deaths this year involving Opana, according to the Jefferson County coroner’s office.

Purdue Pharma should have reformulated OxyContin sooner, said Steven Tolman, a state senator in Massachusetts who led a commission that investigated OxyContin abuse. The company asked the Food and Drug Administration to approve the new version for sale in November 2007; it won the approval in April 2010. It is the first painkiller reformulated to deter abuse, according to the F.D.A., which is now studying several proposed reformulations of other opiate drugs.

“It should not clear their conscience,” Mr. Tolman said of the change. “These people are scientists. Why didn’t they do this years ago?”

Not everyone is convinced that the days of abusing OxyContin are over. The F.D.A. is requiring Purdue Pharma to conduct clinical trials before it can claim that the new version is less abuse-prone. Though many addicts appear frustrated by the reformulation, Dr. Mark Publicker, an addiction medicine specialist at Mercy Recovery Center in Westbrook, Me., said he was “absolutely certain” that people would figure out how to abuse the new OxyContin.

“I like to think of them as drug addict scientists in white lab coats,” he said, pointing to Web sites where drug abusers debate various ways of trying to defeat the new formulation.

Libby Holman, a Purdue Pharma spokeswoman, said that based on initial data and reports, the company is “cautiously optimistic” that the reformulation will eventually prove less susceptible to abuse. But long-term studies will be necessary, she said in an e-mail, adding, “It is still too early to make any conclusions about the product’s impact on abuse and misuse in real-world settings.”

The company has initiated eight epidemiological studies and will report updates to the F.D.A., which approved their design, Ms. Holman said. Meanwhile, the new OxyContin pills have won some unflattering nicknames, said Dr. Ronald Bugaoan, director of psychiatric services at the High Point Treatment Center in Brockton.

“They call them gummies because when you chew them up they get stuck between your teeth,” he said. “They call them jellynoses because when you try to snort it up they get stuck. They cake in the nose.”

Mr. Moore, the recovering addict in East Boston, said that it was possible to snort the new OxyContin but that it took about an hour to break it down.

“It’s like doing a science project,” he said, “sitting there with a scraper, a knife, a razor blade, like it’s a frog or something.”

I find it funny that they call it hillbilly heroin, but it’s a problem in America. I added another sales page for my report here: www.addictedtooxycontin.com.

I am very happy with the success of this report and how much it’s gotten out there because it means that people are finding their way off of the crap.

I was talking to someone earlier this week, who was having trouble getting off the crap and found my report. She was able to get to a doctor the very next day, and entered the outpatient program and had her Suboxone within 2 hours. She emailed me later that day to tell me how much of a miracle drug it was for her too.

She was in her 2nd-3rd day of withdrawal and right after taking her first dose, the pain was gone, the anxiety and depression was gone, her attitude did a 180 degree turn around. She also said for the first time in several years she felt as if there was hope for her. That she would be able to do this thing called getting clean.She hasn’t taken any pain killers since and is on her way to recovery.

It really makes me happy to hear these things from people who email me. This is what I felt too when I got on the program with Suboxone, I felt like I had hope and was able to get off that shit. Man, I can’t tell you how happy I am to be off of that stuff. It controlled every aspect of my life. It was not cool.

Anyway I am going to go enjoy the rest of the day and take my daughter for a walk to the park and push her in the swings. That was something I couldn’t do before without making sure I had some painkillers with me on the walk. Freedom from active addiction is such a wonderful feeling. 🙂

I hope everyone else has a great day!!!

Larry C.