Snohomish County’s heroin epidemic: More resources needed, local experts say

The increase in opioid usage and mortality has hit young people in Snohomish County disproportionately.

Her life as a young child, she recalls, was normal. She lived in a suburban neighborhood with her younger brother, mother and father. She loved to play with her brother in the tree houses her father built for them.

But now, at just 19 years old, Lynnwood resident Emma Tro is a recovering heroin addict — and she can hardly remember the last time her life felt normal.

Tragically, her story is all too common. It is being played out every day on our streets, in our schools and churches, in our parks and public spaces. It drives crime rates up, and imposes a tremendous burden on our social and health services network. Each year it kills scores of people in Snohomish County, and puts countless others in hospitals, emergency rooms and other facilities. And it’s reached epidemic proportions right in our backyard.

Snohomish County ranks at the top of Washington state’s heroin hotspots. While heroin-related deaths increased moderately across both the state and Snohomish County between 2000 and 2009, since 2010 the rate in the county has increased almost threefold (see Figure 1). Ten percent of Washington state residents call Snohomish County home, but a disproportionate 20 percent of heroin overdose deaths occur here.

Fig 1 SnoCoVsWAstate
Figure 1: Heroin-related mortality in Snohomish County increased almost three-fold after 2008, when the FDA mandated that prescription opiates be reformulated to make them more difficult to abuse. Experts say this prompted many addicts to turn from prescription drugs to heroin. (Source for all three charts: “Heroin in Snohomish County, Mortality and Treatment Trends” Snohomish County Health District report, January 2015)

According to Pat Slack, Commander of Snohomish County’s Regional Drug and Gang Task Force, our location helps create a drug epidemic. “When you’re talking illegal drugs, Interstate 5 is the transportation route and Highway 99 is the dispensing route,” he says. “It’s a perfect storm.”

For Emma Tro, drugs have been prominent in her life since the age of 5. Her parents divorced, and her mother quickly remarried to a heroin and meth addict who dealt drugs to help support his habit.

“I remember seeing needles all over the floor,” said Tro. “My stepdad basically turned our home into a crack house.”

The county’s problem was called out earlier this year at a University of Washington symposium on the rising death rate from heroin overdoses in Washington state. Sarah Vogel, Assistant U.S. Attorney for the Western Washington District, named Snohomish County as “the center of the heroin epidemic in Washington state.”

How did it get this bad this fast?

For the answer, we need to look at how the use of opioid painkillers has grown since the turn of the century, and how the well-intentioned efforts to regulate these have had unintended consequences.

“This problem is rooted in the AMA’s (American Medical Association’s) decision back in 2000 to aggressively treat pain,” said Slack. “At the time, no one predicted how many people would become addicted to these substances.”

According to Caleb Banta-Green of the University of Washington Alcohol and Drug Abuse Institute, “hydrocodone is now the most prescribed drug in Washington State.” Overdoses from these drugs increased through 2008, and in response the U.S. Food and Drug Administration mandated tighter regulations and drug reformulations with the goal of making them less easy to obtain and abuse.

While these efforts resulted in a marked decrease in prescription drug overdose deaths in subsequent years (see Figure 2), it was accompanied by an unintended consequence — an increase in unregulated drugs being smuggled into the county and the rise of heroin as a substitute for these.

Figure 2:
Figure 2: As deaths from prescription opiate overdoses decreased after 2008, heroin deaths increased as addicts moved to the cheaper, more potent, and more readily available heroin.

“It’s like playing whack-a-mole,” Slack said. “Sure, reformulating the drug so it couldn’t be dissolved and injected made it tougher to abuse, but that just brought in more of the original drug from Mexico and other places outside our borders where it was still being manufactured. The street price of oxy shot up, and the illegal importers started sending in heroin to take up the slack. Today you can pay $10 on the street for an amount of heroin that is equivalent to $80 worth of oxycodone.”

Kyra Ripley, a chemical dependency counselor, sees this connection every day. ” I always ask my clients how they got started, and across the board they’ve started with oxycodone and turned to heroin,” she says.

Sadly, the increase in opioid usage and mortality hits our young people disproportionately (see Figure 3). According to Banta-Green, “in 2012, 10 percent of Washington state 10th graders admitted to using opiates to get high in the past month.”

Figure 3:
Figure 3: Heroin Mortality Rates by Sex and Age.

Why do teens start? Banta-Green cites four major triggers to begin using: sensation seeking, social peers, physical pain, and family norms. That last trigger refers to the many teens who grow up seeing parents and others overusing and abusing drugs and painkillers. “If you grow up hearing people complain about pain and taking pills to address this, and seeing people using drugs recreationally, you’re more likely to carry this pattern into later life,” he said

For Emma Tro, who lived in Edmonds during her teen years, drugs quickly became a catalyst for trauma in her life, trapping her in a downward spiral of substance abuse and addiction. From a stepdad who became abusive after staying up for days at a time while high on meth, to her mother committing suicide when Tro was 8, drugs permeated her life. It was all she knew. To her it was normal.

She began experimenting with marijuana and alcohol at age 12, and on her 14th birthday shot heroin into her veins for the first time.

“You see those commercials, you know, that say ‘not even once,'” said Tro. “I shot up one time, and from then on it ruined the rest of my life.”

Opioid addiction not only creates problems for the individual addict, but for family, friends and the community as well. To be addicted is to be continually in search of the next fix, the next opportunity to get high. It becomes an all-consuming focus. To get money to feed their habits, addicts often resort to theft and other crimes, sending ripples through the community that touch all of us.

“You don ‘t have to look very far to see how addiction is affecting each and every one of us,” says Ripley. “It’s a cultural issue.”

Law enforcement is one area where the burden falls heavily.

“Residential burglaries in our community are up 20 percent since last year,” said Edmonds Police Chief Al Compaan. “This is an all-time high for us. Addicts need to raise money fast, so these burglaries are typically not planned out. They’re crimes of opportunity, committed by someone who is looking for something that can be turned into cash the same day, which can then be used to purchase drugs. And all too often the pattern repeats the next day, and the day after that, and the day after that.”

While arrests are made, our region’s overburdened justice and prison systems mean that many perpetrators won’t go to prison, and will be released back into the community.

“They’ve learned that they can commit these crimes with very little risk of penalty even if caught,” Compaan said. “Even those who go to prison receive little effective treatment or counseling, and upon release many simply go back to their old ways.”

Compaan summed it up by saying, “We’ve learned that we simply can’t prosecute or arrest our way out of this.”

Indeed, all concerned — police, public health officials, prosecutors, social service professionals and physicians — agree that the heroin problem does not respond to simple solutions, and that it is best addressed by a multi-faceted approach that combines medical treatment, psychological therapies and counseling with traditional law enforcement.

According to Snohomish County’s Pat Slack, building an effective social services net is the critical first step. “I’ve been at this for 46 years,” said Slack, “and if there’s one thing I’ve learned it’s that people need food and shelter or they’ll commit criminal acts. The county needs to do a better job of taking care of people in need. Until we aggressively pursue this, we’ve got a problem.”

While many programs do exist, their efforts are often piecemeal, serving only a select group of the needy population. “If you’re young, pregnant or have dependent kids you can find some help,” he says. “But if not, and you’re between 16 and 60 you’re out of luck. The sad fact is that we’re burying a lot of people who don’t need to die.”

Ripley agrees. ” Help is out there, but there could be more with more funding. Projects like The Handup Project, the Hoff Foundation, Esther’s Place, and detox centers are around to help addicts recover, but they need funding to grow.”

Emma Tro was one of the lucky ones. After spending her teenage years doing heroin in the bathrooms of Edmonds-Woodway High School and Scriber Lake High School, and robbing her father’s house for drug money, in the fall of 2013 she found herself sharing a cramped, damp, one-person tent with three other people, shooting up heroin and doing meth.

“People say that drug addicts need to hit rock bottom to get help,” Tro said, “and I’ve hit rock bottom thousands of times. And then one day it just clicked in my brain. I really can’t explain why it clicked when it did, but I just knew that I was sick of it, had enough and wanted help.”

Almost two years later, Tro has been clean for 13 months. But her battle with drugs and addiction is far from over.

Her longtime heroin use has left her with collapsed veins in her arms that cause circulation issues, social anxiety, and depression. And while she hasn’t used heroin for more than a year, she needs medication to fight the urge to get high.

“I’ve learned that I can’t really change the past,” Tro said. “I can only focus on making my future better and staying clean.”

Kyra Ripley agrees. “Until recovery, nothing is stronger to an addict than the addiction,” she said. “They need to learn to become addicted to life as much as they are addicted to the drug to stay clean.”

— Story by Larry Vogel with reporting by Olivia Fuller

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