Take a moment to really study this photograph, and when you finally need to look away, consider this:
It happened in the bucolic hamlet of East Liverpool, Ohio, a town of 11,000 nestled along the north bank of the Ohio River. It is best known for its pottery and as the final destination for the body of gangster Pretty Boy Floyd.
The couple in the front seats had, moments before this picture was taken, OD’d on heroin. Both have white, bloodless lips. The woman slumps over, eyes open and unseeing, while a police officer reaches in to check for a pulse. (There was one, and both survived after being administered naxolone, an overdose antidote. Otherwise, police said, the two would almost certainly have died.)
The East Liverpool police officer who conducted the traffic stop said the driver was trying to tell him that he was transporting his passenger to the hospital when he lost consciousness.
But the most shocking element is the curly-haired little boy in the back seat (face blurred for anonymity). He sits blankly, impassively, betraying no emotion as he stares at the camera from his booster seat. He is just 4 years old, but he has clearly seen this before. The woman is his grandmother.
The appearance of this photo on the internet triggered a firestorm of outrage for its horrific intimacy. That debate continues. So why, in all of our self-righteous horror, are we looking at it?
Because it could just as easily have happened here. The heroin and opioid epidemic sweeping the nation has not spared “God’s Country,” as some local politicians like to call it. The number of Kitsap County’s recent deaths-by-heroin has jumped suddenly, and show no signs of slowing down. The subject is so front-and-center in the national dialogue that it drew a mention on President Barack Obama’s weekly radio address. The epidemic has even become part of the presidential campaign.
Perhaps a recent press release from the Bremerton Police Department best illuminates the brewing storm: A 31-year-old woman was with a friend. The friend, Nicole Browitt, called her dealer, Christopher Fletcher, (street name “Cupcake”) to score some heroin for the victim. According to Bremerton police, it is likely the victim administered her own fatal dose. But dead she was. Now, Browitt and Cupcake face charges of controlled substance homicide. Browitt is being held on $250,000 bail; Cupcake faces multiple charges and $260,000 bail.
A short chemistry lesson is in order.
Whether the discussion centers on heroin, oxycontin, codeine, hydrocodone or another dozen or so opioid variants, the drug in question is essentially the same thing.
“The only real difference between heroin and oxycontin,” said a physician who works in the emergency room at Harborview Medical Center in Seattle, “is the method of delivery.”
Our bodies, says University of Washington researcher Caleb Banta-Green, are hard-wired to like opiates, because they stimulate the area of the brain, the nucleus accumbens, that gives pleasure. The same area helps produce endorphins (which are nothing more than our bodies’ own self-made illicit drug) at the end of a bracing jog or sex.
According to research by the Associated Press, more Americans are dying from opioids than at any other time in recent history. Overdose deaths hit 28,000 people nationally in 2014, and that number is markedly higher than just two years earlier.
It isn’t just illicit opiates that are responsible for the carnage — it’s legal prescription painkillers, from which overdose deaths have quadrupled since 1999.
Sergeant Billy Renfro, a member of the Special Operations Group for the Bremerton Police Department, has seen it all up close, and he agreed.
“It has gotten dramatically worse,” Renfro said. “Six years ago, when I left the drug enforcement unit, meth was the big thing, and heroin wasn’t even on our screen. Now heroin is the dominant drug when it comes to overdoses. Heroin has taken over.”
So what is the attraction?
Heroin is cheap; a simple one-hit dose runs about $10 on the street corners of downtown Seattle, and the high lasts all day. Where it gets expensive is the rapid growth of the addiction. Before long, a hit that will reproduce that delicious high (and stave off the growing withdrawal symptoms) begins to inch toward $50 and then $100 — per day. For a person with little or no legitimate income, a common choice is to start dealing it.
Heroin is actually not the most popular form of opioid. This is pills, which have the advantages of being clean, more socially acceptable, easy to hide and fetch a good deal of money on the street — up to $25 each.
“Addicts seem to enjoy the pills better,” said Sgt. Renfro. “They’re easy and clean. Smoking heroin seems to produce the best high, but addicts don’t like it because it doesn’t taste very good.”
Pills are seen by law enforcement agencies as a gateway drug to heroin.
And, he added, the demographics of addiction are changing as well. No longer is it homeless people or drug dealers — it’s young people, well-dressed people, professionals and homeowners.
In other words, people just like you.
This image shows how the 1/10th funding is utilized as a continuum to work on chemical dependency starting early in schools through adult drug court and then jail new start program. Image courtesy of Doug Washburn
According to Renfro, 80-90 percent of overdoses are from some form of opiate — heroin, pills, suboxone, methadone (a drug developed to cure heroin’s potentially fatal withdrawal symptoms) and oxycontin and its derivatives.
One of the newest, most monstrous form of opioid to appear is fentanyl, which is a laboratory-grade opioid that is up to 100 times more potent than heroin. But it is chemically indistinguishable from heroin, and there is no way for most street-level users to gauge how much fentanyl has been laced with an otherwise manageable dose of heroin. If it happens to be too much, it can get ugly.
Music fans will recognize the name. It is the painkiller that killed Prince. He started taking it to deal with the pain of two hip replacements.
But the worst of it may be yet to come. In just the past few months, still another form of opioid is creating new carnage on the street: a synthetic opioid call carfentanyl, which is so potent it has no human uses. It was developed as a sedative for elephants, and at 100 times more potent than even fentanyl, it is so powerful the simple act of touching it can be deadly dangerous.
The source of this flood of opioids usually starts in a doctor’s office, since addicts usually have few other sources. In the past few years, it has become commonplace for physicians to prescribe opioids to fight chronic pain. Often those pills, due partly to their great value, make it to the street.
And the tragic results of this sudden glut of dangerous drugs is showing up at the Kitsap County Coroner’s Office. For the purposes of this comparison, we’ll look at the rates of actual fatalities in Kitsap County — not just users who overdosed and got lucky.
So here are the statistics for Kitsap County drug overdoses (the first number is the total number of fatal overdoses; the vast majority of non-opiate deaths is methamphetamine). Statistics courtesy Kitsap County Coroner’s Office:
Total Fatal overdoses: 17
Opioid overdose: 12
Total fatal overdoses: 17
Opioid deaths: 12
Total fatal overdoses: 26
Opioid fatalities: 11
Total fatal overdoses: 44
Opioid fatalities: 19
POST SCRIPT: The little boy in the photo was taken from his mother and placed the custody of his grandmother.