The Washington PostDemocracy Dies in Darkness

The heroin epidemic’s toll: One county, 70 minutes, eight overdoses

A view of Washington, Pa. Last week, Washington County recorded 16 overdoses in 24 hours and 25 over two days. Three people died. (Marvin Joseph/The Washington Post)

The first call came at 7:33 p.m. last Sunday: Two people had overdosed on heroin in a home just a few hundred yards from the station where firefighters were awaiting their nightly round of drug emergencies.

Six minutes later, there was another. A 50-year-old man had been found in his bedroom, blue from lack of oxygen, empty bags of heroin by his body.

At 8:11, a third call. Then another, and another, and another and another.

By 8:42 — 69 minutes after the first report — a county of slightly more than 200,000 people had recorded eight overdoses, all believed to be caused by heroin. There would be a total of 16 overdoses in 24 hours and 25 over two days. Three people died. Many of the others were saved by a recent decision to equip every first responder with the fast-acting antidote naloxone.

The toll wasn’t from a supply of heroin that had been poisoned on its journey from South America to southwestern Pennsylvania. Nor was there an isolated party where careless junkies miscalculated the amount of heroin they could handle. Last week was simply an extreme example of what communities in parts of the country are enduring as the heroin epidemic rages on.

“It’s absolutely insane. This is nuts,” said District Attorney Eugene A. Vittone, a former paramedic who is trying to hold back the tide of drugs washing across Washington County, a Rust Belt community 30 miles south of Pittsburgh. On any day, Vittone said, the county averages five to eight overdoses, almost all from heroin. More are recorded each day in towns just over the county line.

“There’s been a progressive increase in overdoses the last two years, and it just went out of control,” added Rick Gluth, supervising detective on Vittone’s drug task force. “I’ve been a police officer for 27 years and worked narcotics for the last 15, and this is the worst. I’d be glad to have the crack epidemic back.”

Cheap fix: Heroin’s resurgence. ‘And then he decided not to be’

The United States averages 110 overdose deaths from legal and illegal drugs every day. The heroin death toll has quadrupled in the decade that ended in 2013, according to the Centers for Disease Control and Prevention. By all accounts, it has only grown worse since. In Washington County, there have been more than 50 fatal overdoses this year.

The national drug-death total, larger than that from auto accidents, is disproportionately concentrated in the Rust Belt, the Great Lakes region and the Northeast.

“There is a growing sense of community outrage that we can’t accept this like we are accepting it,” said David J. Hickton, U.S. attorney for western Pennsylvania and co-chair of the National Heroin Task Force established by the Justice Department in April. “We just can’t go on like this.”

In this working-class community near the Monongahela River, where drilling for gas deposits has begun to stoke an economic revival, there is little sign that anything will change soon.

“I’m destroyed. I’m totally destroyed,” Valerie Mack said Thursday on the front porch of the home she shared with her brother and several other people on a modest block here.

Her brother, Sammy Mack, the second overdose victim in the Sunday night skein, was found dead in his bedroom, curled in a fetal position. Near his body were “stamp bags” of heroin — small paper packets that most closely resemble chewing gum wrappers. They bore the supplier’s brand, “MADE IN COLOMBIA.”

The label is one of two flooding the area, Gluth said. The other is stamped “BLACK JACK.” Authorities are still investigating but believe both types of heroin are laced with fentanyl, a powerful synthetic opiate that increases the drug’s potency and may have contributed to the rash of overdoses.

Sammy Mack had long had problems with alcohol and was not unknown to law enforcement authorities. But as so many others have, his sister said, he turned to heroin after treatment with narcotic painkillers prescribed for an ankle injury he suffered a few months ago. Mack’s divorce was recently finalized, she said. His four children are living with his ex-wife not far away.

When life begins in rehab: A baby heals after a mother’s heroin addiction

As he began to use heroin, Mack’s habits and personality changed, she said. He became withdrawn, spending more time in his room. That Sunday, she was fixing him a chef’s salad and became suspicious when he didn’t respond to her calls. She tried to push open his bedroom door but couldn’t. A neighbor finally forced his way in.

Mack’s prized possession, a Harley-Davidson motorcycle, still sits in the home’s back yard. He had promised it to his 14-year-old son upon his high school graduation. “I’ll just have to follow through,” Valerie Mack said.

With so much awry in Sammy Mack’s life, his sister said, “Maybe the Lord intervened and decided just to take him.”

Jessica Neal, 26, another of last week’s overdoses, is still alive after a close call. She was found unconscious in a bathroom at a local Walgreen’s on Monday, her 2-year-old strapped in a stroller in the stall with her. She was revived with naloxone.

Her father, Sonny, who has a different last name that he requested not be used to protect his privacy, said he threatened to have her committed to the psychiatric unit of the local hospital that same day after Neal spoke of committing suicide. Instead, she agreed to sign herself in. She was released Friday and headed to jail. The child is in her father’s care, he said.

“She doesn’t need jail,” Sonny said outside the home where the two lived with Sonny’s wife, who suffers from amyotrophic lateral sclerosis (ALS), until last week. “She wasn’t out stealing or doing crimes. What she needs is help. She needs to be in rehab. And after rehab, she needs to be in a halfway house.”

Nationally, there are only a small fraction of the inpatient drug rehab beds needed for addicts, but Hickton, in an increasingly common stance for prosecutors, has agreed that users need help more than they deserve incarceration. Even as he has stepped up prosecution of dealers, he is taking a multifaceted approach to the current problem.

“If they’re using and trafficking, I prosecute them,” he said. “If they’re just using, they need help.”

Hickton promises to bring homicide charges against any seller he can link to a death. But that is easier said than done. There are no open-air drug markets in this epidemic like the ones that captured public’s attention during drug outbreaks of past decades. Much of the commerce is conducted on cellphones and by word of mouth.

With many more middle-class people addicted via prescription opioids this time around, heroin is bought and sold in bars, nightclubs, homes and more unlikely places, said Neil Capretto, an addiction psychiatrist and medical director of Gateway Rehabilitation Center, which has 20 locations in the Pittsburgh area.

Gluth said he has undercover detectives all over the streets making buys, painstakingly working their way up the chain in search of bigger dealers.

He believes the latest load of heroin came from New Jersey, but Washington County’s location makes it particularly vulnerable to drug traffic. Not far from the Ohio and West Virginia borders, it sits at the intersection of Interstates 70 and 79, east-west and north-south conduits for drugs and everything else. Vittone said the county receives drugs from New York, Newark, Washington, Chicago, Detroit and elsewhere.

“We’re kind of like ground zero,” he said.

On the streets here, prescription drugs are selling for about $1 per milligram, or $20 for a single dose. Heroin is much cheaper, at about $8 a stamp bag, Gluth said. It is also much more potent than the heroin of previous eras, Capretto said. Users often start with a single bag, but as their resistance grows, they need increasing amounts.

All of which signals more overdoses and deaths, at least until authorities can find ways to stem the demand and the supply.

“If we had a serial killer killing one-tenth as many [people], we’d have the National Guard here,” Capretto said. “We’d have CNN here every night.”