Norris could only shake her head at the surge in attention to heroin after Hoffman's death. "Well, duh," she says, "it's been happening to our kids every day — and nobody sees it."
A couple decades ago, the big problem in Hamilton was cocaine. That shifted to prescription drug abuse, which morphed into heroin as pharmaceuticals grew harder to come by. Now heroin-related deaths have more than tripled in Butler County, where Hamilton is the county seat. There were 55 deaths last year, and within one two-week period, the city's emergency paramedic units responded to 18 heroin overdoses. Once, they had five overdose runs in a single day.
Users run the gamut, says EMS veteran Jennifer Mason — from streetwalkers to business executives. They die in cars, public parks, restaurant bathrooms, a university building. Mason has found people turning blue with needles still in their arms.
Sojourner Recovery Services, an addiction treatment organization in Hamilton, has a six-month waiting list for beds for male addicts.
Romanello's hospital saw 200 heroin overdose cases last year, and countless related problems: abscesses from using unsterile needles, heart-damaging endocarditis and potentially fatal sepsis infections.
Overdose patients usually bounce back quickly after given naloxone, known by the brand name Narcan. It works by blocking the brain receptors that opiates latch onto and helping the body "remember" to take in air.
At least 17 states and the District of Columbia allow Narcan to be distributed to the public, and bills are pending in some states to increase access to it. Attorney General Holder has called for more first responders to carry it. Last month, Ohio's Republican governor signed into law a measure allowing a user's friends or relatives to administer Narcan, on condition that they call 911.
Romanello says his patients are usually relieved and grateful by the time they leave his hospital. "They say, 'Thank you for saving my life,' and walk out the door. But then, the withdrawal symptoms start to kick in."
"You would think that stopping breathing is hitting rock bottom," adds Mason. "They don't have that fear of dying. You've blocked the heroin, and they have to have it. They go back out to get more. You haven't fixed their addiction."IN OREGON: A FORMER ADDICT FIGHTS BACK
Before 9 o'clock every weekday morning, the secret to one of the most successful drug rehabilitation clinics in Portland, Ore., waits behind a locked door. Meet David Fitzgerald, leader of the mentor program at Central City Concern, which claims a 60 percent success rate for treating heroin addiction.
The lock, Fitzgerald says, is a necessity because his addicts will take every opportunity offered, including early access to the "mentor room."
Inside, the walls are covered in photos, including a collage from last year's group picnic. Recovering addicts smile and hold plates of food. Seven months later, Fitzgerald looks over the faces. Are they all still sober? Are they all still alive?
"Most of them," he says. "Not all."
Heroin cut a gash through the Pacific Northwest in the 1990s. Then prescription pills took over until prices rose. Now the percentage of those in treatment for heroin in Oregon is back up to levels not seen since the '90s — nearly 8,000 people last year — and the addicts are getting younger.
Central City's clients reflect that. In 2008, 25 percent of them were younger than 35. Last year that went to 40 percent.
"A lot of them aren't ready at a younger age," Fitzgerald says. "The drug scene, it's fast ... it's different. It's harder than it was."
Fitzgerald, 63, speaks with a laconic prison patois, a reflection of 20-plus years incarcerated, all the while addicted to various drugs. The worst was heroin. In 1997 he got sober, and in 1999 he joined Central City Concern, then a burgeoning outfit.
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