Deaths from drugs and alcohol in Boston soared dramatically in
2006, an
increase fueled by cheap heroin, the allure of crystal
methamphetamine, and
the widespread availability of addictive prescription medications.
Boston health authorities are so alarmed by the spike in
fatalities - 176
people died from substance abuse in 2006 - that they are scouring
medical
examiner reports on each case, hunting for clues that might further
explain
the precipitous rise. In that year, the number of people dying from
drugs
and alcohol climbed 32 percent, reflecting a decadelong trend
sweeping the
state.
The findings, detailed in a draft of the annual Health of Boston
report
obtained by the Globe, ranked substance abuse as the fifth-leading
cause
of death, with Bostonians three times more likely to succumb from
drugs or
alcohol than from homicide.
"It's really difficult when you talk to these parents of
25-year-old kids
and they don't even suspect their kid has a problem, and then
they're
dead," Michael Botticelli, director of the state's Bureau of
Substance
Abuse Services, said, his voice catching. "It's hard when you feel
like
you're doing everything in your power to make a dent in it - and I
do think
we're making progress - but the challenges are enormous."
That was evident in just the past week: Boston police are
investigating
three deaths since last Friday that they suspect were related to
drugs, a
spokeswoman said. One person was found dead in Franklin Park;
another, in a
Brighton apartment; and a third crumpled in a stairwell in the
South End, a
neighborhood where more people die from substance abuse than in any
other.
"We easily see an overdose a day," said Rich Serino, chief of
Boston's
Emergency Medical Services. "And some days, more."
Sometimes the users survive; sometimes they don't. Their arrival
at such
dire straits reflects the resurgence of heroin, which is an old
drug of
choice, and, increasingly, the compression of the journey to
life-threatening addictions.
Substance-abuse specialists trace the roots of the latest spike
in deaths
back to the late 1990s, when heroin began to tighten its grip on
New
England. It was a classic case of market-driven economics: The drug
was
cheap, with a hit of heroin selling in some neighborhoods for less
than a
six-pack of beer.
And the heroin was so powerful that novice users didn't have to
inject it.
They could get high just snorting the powder, erasing some of the
stigma
that marked heroin in an earlier era, of arms pocked with needle
tracks.
But once hooked, users inevitably turned to needles, which
promised a more
potent delivery method. And when that wasn't enough to satisfy
their
craving, addicts sought dealers who peddled heroin boosted with
other
narcotics, such as the powerful painkiller fentanyl, creating an
especially
potent brew.
"They use it once and they say, 'Oh that was fabulous,' and
then it takes
hold of a whole group, and it gets passed on," said Rita Nieves,
director
of substance abuse services for the Boston Public Health
Commission.
"Then, you see a spike in fatal overdoses."
Those deaths have not been confined to Boston: Statewide, annual
opiate-related deaths climbed from 94 to 637 between 1990 and 2006,
the
latest year for which complete figures are available.
That jump coincides with the arrival of crystal meth in New
England. Though
not the scourge in the region that it is elsewhere, meth has
resulted in
more addicts seeking treatment, specialists said.
At the same time another new path to addiction started gaining
popularity:
prescription pain relievers, easily accessible in many a family
bathroom.
"Our youth have become increasingly sophisticated, and they
say, 'It's
difficult to go buy booze, it's difficult to buy cigarettes, but I
can open
the medicine cabinet at home and find a whole host of things,"'
said Kevin
Norton, president of CAB Health & Recovery Services Inc., a
Boston-area
treatment network.
They find Percocet, OxyContin, and other powerfully
habit-forming pain
pills. And so the path from casual user to desperate addict - once
winding
from tobacco to alcohol to marijuana, and then on to more dangerous
substances - becomes perilously shortened.
Once cut off from family members' supply, users resort to street
dealers
who may charge $50 or more for a pill. No longer able to afford
that steep
price, prescription drug users switch to heroin and other
comparatively
affordable narcotics, which can sell for as little as $5 or $10 a
bag. And
they often progress to using multiple drugs at the same time,
compounding
the dangers.
"I see, across the neighborhoods, people talking about the
combinations of
drugs," said Beth Rosenshein, coordinator of the Charlestown
Substance
Abuse Coalition. "Oftentimes, people using heroin are also
shooting
cocaine or smoking crack or drinking."
Barbara Ferrer, executive director of the city's Public Health
Commission,
said she expects a team analyzing the fatal overdoses to complete
its work
within a couple of months.
"We're anxious to get this information. We're anxious to
understand this,
and we're anxious to look at our programming," Ferrer said.
Already, investigators know that more than three-fourths of the
2006 deaths
were caused by drugs, with the remainder attributed to alcohol
poisoning or
alcohol-related diseases. And while the majority of victims were
men - 122
- the number of women dying from substance abuse nearly doubled
from 2005,
when it was 29, to 54 in 2006.
This year, the state is spending nearly $128 million to treat
substance
abusers and to prevent people from getting hooked in the first
place. That
is a 58 percent increase from just five years earlier.
Phyllis Avery, who has spent roughly half her 43 years in the
thrall of
alcohol and crack cocaine, has seen the dead and near-dead on
Boston's
streets.
"It did scare me," she said, "but when you are caught up in
your disease
and you are using constantly, you block that out of your mind."
At a certain point, she said, addiction wears you out. That's
when she
enrolled in a new city initiative underwritten by $500,000 a year
in
federal funding, part of a broader campaign by the city to expand
services.
Like 70 other women this year, Avery is spending 10 to 30 hours a
week
with counselors and other recovering addicts, learning how to rein
in anger
and rebuild their lives.
"Life is so much better compared to what you go through when
you're right
in the middle of addiction," she said.
Maria Cramer of the Globe staff contributed to this report.
Stephen Smith
can be reached at stsmith@globe.com.
c.2008 The Boston Globe