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Lori Gonsalves, after a news conference at the fire station in Taunton, Mass., holds photos of her son, Cory Palazzi, 25, who is disabled after overdosing on heroin.Elise Amendola/AP
At the age of 26, Brian Hamlin was flying high. A former standout wide receiver at Curry College in Milton, Mass., with two Division III conference championships under his belt, he had become a star in the corporate world, too, and was making six figures selling software.
Hamlin was also addicted to painkillers, a sickness he’d first caught after being prescribed Vicodin and Percocet for football injuries at 19. “I would close deals, large deals, under the influence,” said Hamlin, now 32. “If I was under the influence of opiates, anything I did was great.”
But when the recession hit in 2008, Hamlin was laid off, and his addiction prevented him from finding work. Without the money to support the painkiller habit, he turned to heroin — a habit he could support with petty crime. He overdosed multiple times. His mother once found him passed out on the bathroom floor with a needle sticking out of his arm. Before 2008, “I would have cringed at a hypodermic needle and been horrified,” said Hamlin. “Now it looks like a pen or a pencil, just another utensil, because it became another part of my life.”
With his family’s support, Hamlin eventually kicked the habit. He’s found work with an understanding businessman willing to overlook his rap sheet of nonviolent crimes, and is once again blowing away sales targets.
Though the outcome is not always so happy, Hamlin’s story is a typical one in the deadly opioid epidemic that has quietly taken hold in New England. Abuse of prescription painkillers and natural opiates like heroin skews young and white here, and it’s gripped urban, rural, and suburban communities alike.
The epidemic’s origins can be traced to the increased availability of prescription painkillers. Its growth can be attributed to inadequate treatment resources and the silence about addiction demanded by middle-class mores. Only this winter, as fatal heroin overdoses have spiked across the region, have governments and the public begun to recognize the scope of the problem and moved to more vigorously address it.
The epidemic’s origins can be traced to the increased availability of prescription painkillers. Its growth can be attributed to inadequate treatment resources and the silence about addiction demanded by middle-class mores.
In New England, heroin was once associated mostly with isolated summer colonies like the islands of Nantucket and Martha’s Vineyard, where bustling tourist seasons give way to long, lonely winters for many year-long residents. But starting in the 1990s, the availability and overprescription of powerful, addictive painkillers like Oxycontin created a new population of opioid addicts throughout the region. As regulators and doctors have tightened the supply of painkillers, a substitute has gained currency.
“The pills dried up, and people are addicted, and what do they turn to? Heroin. It’s available and it’s cheap,” said Max Sandusky, who works with users as the director of prevention and screening for the AIDS Support Group of Cape Cod, in Massachusetts. Increased demand has pushed the heroin trade farther north and east from urban hubs in New Jersey and New York, making the drug a plentiful alternative to painkillers. It’s also a dangerous one. “You’re buying heroin off the street,” said Sandusky. “You don’t know what it is. You don’t know its purity.”
The numbers are striking. In Maine, heroin overdoses quadrupled between 2011 and 2012. In New Hampshire just a few years ago, the number of annual heroin overdose deaths hovered in the single digits. In 2012, the state saw 37 heroin deaths, and last year it saw at least 63, with dozens more possible cases still pending.
Though the trend is most striking in the Northeast, it’s a national problem. The number of heroin users doubled across the U.S. between 2002 and 2012, to 335,000, according to the Substance Abuse and Mental Health Services Administration. Deaths from drug overdoses have tripled nationwide since 1990, thanks mostly to opioids.
This winter, fatal overdoses have spiked to new highs across New England, a trend that’s been linked to heroin laced with the highly potent painkiller Fentanyl, and the public has begun coming to terms with the size of the epidemic. In January, Vermont Gov. Pete Shumlin dedicated his entire State of the State address to the “full-blown heroin crisis.” In February, following a spate of fatal overdoses, the Rhode Island State Police announced that all of their cruisers would carry naloxone, a drug often called by the brand name Narcan that can reverse heroin overdoses. Also in February, Boston Mayor Marty Walsh called for all of the city’s first responders to do the same, amid a similar rash of deadly overdoses in Massachusetts that claimed the son of a close friend of the city’s police chief.
Because they address the most immediate danger, efforts to increase naloxone access have been among the first measures for addressing the crisis. But in Maine, Gov. Paul LePage, a tea party favorite, has blocked access to the lifesaving drug. Last year, LePage vetoed a bill widening access to the drug because he said it would provide ‘‘a false sense of security that abusers are somehow safe from overdose if they have a prescription nearby.’’
Liz, 47, a former heroin addict living in Quincy, just south of Boston, does not buy that reasoning. “Everyone knows CPR, but you don’t see us all dropping on the ground to get CPR,” said Liz, who once received naloxone during an overdose and asked that her full name not be used in connection with her illegal drug use. Addicts, she said, are “going to be reckless anyways.”
This year LePage’s administration is again fighting efforts to expand access to the drug. A spokesman for the governor cited February testimony by state officials pointing to fiscal obstacles to increasing naloxone access and casting doubt on its medical efficacy.
But medical experts view the drug as an essential tool. A study published last year in the British Medical Journal found that training and access to naloxone significantly reduced overdose deaths. “It works,” said Dr. Jessie Gaeta, medical director of Boston Health Care for the Homeless. “It definitely saves lives.” Gaeta said that friends and family members of addicts should be trained to administer naloxone and have access to it.
But while naloxone does save lives, it doesn’t treat addiction or address its roots.
“I think Narcan is like a Band-Aid,” said Cathy Gilmore, 50. “It works. Obviously we need it.” But Gilmore, whose son Anthony died in September at age 27 after more than a decade of addiction, is pushing for more.
Anthony was fatally struck by a train less than an hour after being released from a hospital while still intoxicated with heroin. Now his mother is working with her state representative from Franklin, Mass., on a bill that would require hospitals to hold patients who are intoxicated on opioids until they’ve sobered up.
Beyond the immediate danger of excessive intoxication, public health professionals, addicts and their family members say there’s a shortage of in-patient detox and rehab facilities. When addicts are ready to check in to rehab, “those beds are often not there,” said Gaeta, “or the waiting list for those beds is often weeks long.”
Gilmore, whose husband also died while high on heroin, said Anthony struggled to get sufficient treatment. “A seven-day treatment isn’t going to work,” she said, but longer treatment has become harder to come by. “What is a drug addict going to do when he’s high on heroin and they tell you, ‘You can’t come today’?” she said.
Hamlin, who said he went through more than a dozen detox programs, said short stays don’t cut it. But cost-conscious insurance companies have cut back on coverage, and Hamlin said the norm has gone from 28-day inpatient treatment to six days or less. Often, drug dealers park outside of rehab facilities, and addicts begin using as soon as they step out the door.
In addition to stepped-up police efforts, many governments across the region are either considering or implementing measures to grant amnesty to people who call in overdoses to 911 and to compile statewide databases that will prevent addicts and dealers from doctor-shopping for pills. In October, the U.S. Food and Drug Administration proposed tighter guidelines for prescribing painkillers that could come into effect this year.
Both Hamlin and Gilmore said the epidemic has festered for so long in part because the shame of addiction and the isolation of suburban living has prevented it from being dealt with out in the open.
“Back in the day, everyone watched each other’s kids,” said Gilmore, who grew up in Boston before moving her young family out to the suburbs two decades ago. “Everyone knew your business. You couldn’t get away with stuff.
“I don’t see that anymore,” she said. “A lot of people don’t care. It’s not their kid.”
Hamlin said that families often treat addiction as a “dirty secret,” which prevents communities from coming together to confront it. The most important solution for addressing the root of the problem, he said, is “awareness.”