Heroin: How Did We Get Here?

Heroin’s deadly hold on the Cincinnati region is indisputable. How did it happen? A brief history.

Our car was holding up traffic at the corner of West 66th and Rosewood in front of a white, two-story building on the border of Elmwood Place and Carthage. Until September, this house served as the headquarters for Phillip Watkins and Jeanetta Crawford, believed to be the first people in the country indicted for allegedly selling carfentanil, the most lethal opioid derivative known to man.

As we inched forward, a woman behind us jumped out of her black Chevy Silverado and bolted down the sidewalk. Elmwood Place police chief Eric Bartlett flashed the lights on his squad car and sprinted after her. In short order, the suspect was caught and arrested; three heroin needles and a crack pipe were found in her truck. Three cop cars, an ambulance, and a fire truck crowded the residential street as neighbors watched from their porches. None of them seemed too surprised. In this part of town, such incidents have become all too common.

How did Cincinnati get to the point where a foot chase at 1 p.m. on a Tuesday leading to the arrest of a desperate heroin user is just an ordinary day?

“We have a heroin problem because we had, and still to a certain extent have, a pill problem,” says Ben Glassman, acting United States Attorney for the Southern District of Ohio.


Illustration by Headcase Design

Understanding the proliferation of prescription opioids in the United States is key to comprehending the heroin epidemic. The abbreviated explanation goes like this: Beginning with the FDA approval of OxyContin in 1995, drug companies began mass-marketing painkillers, often downplaying their addictive nature, and doctors began prescribing them at an alarming rate. Ohio pharmacies and practitioners went from distributing 865.8 kilograms of oxycodone (the generic form of OxyContin) in 2000 to 3,038 kilograms in 2010, the fifth highest amount of any state in the country.

As the quantity of pills rose, so too did the number of addicts. In 2006, drug overdoses surpassed motor vehicle accidents as the top cause of accidental death in Hamilton County for the first time since such stats have been tracked. It’s stayed that way ever since. When the government started cracking down on illegally distributed pills in the mid-aughts, many opioid addicts turned to heroin as a cheaper option. By 2013, 182 of the county’s 259 overdose deaths—70 percent—tested positive for heroin.

There was further cause for alarm as well. According to Lakshmi Sammarco, who took office as county coroner in 2012, a handful of toxicology reports from 2013 also showed traces of fentanyl, a synthetic opioid pain medication generally administered intravenously during surgery. “We were scratching our heads—fentanyl?” she says.

Heroin and fentanyl have a similar impact, both binding to the same reactors in the brain, but fentanyl can be up to 100 times stronger than heroin. “We started getting reports that some Mexican cartels were deliberately lacing the heroin with fentanyl to make it that much more addictive,” says Sammarco.

This is when the problem spiraled from epidemic to cataclysmic. The synthetic nature of fentanyl made the heroin not only easier, faster, and cheaper to produce, but also more deadly. In 2015, Hamilton County had a record 414 OD deaths. Fentanyl was involved in 237, a trend reflected throughout the region.

“I’ve devoted my last 10 years of work towards strictly heroin,” says Tim Reagan, an agent with the Drug Enforcement Administration. “I didn’t ever think it would get worse than heroin.”

Things crested this past summer when carfentanil, an animal tranquilizer that can be up to 100 times stronger than fentanyl, hit the streets. It resulted in an unprecedented 174 reported ODs over a six-day span in late August. Prior to that, the city averaged only four overdoses a day. Merely identifying carfentanil as the culprit was a significant challenge. “It’s not a human drug,” says Sammarco. “I’m reading veterinary medicine articles. How do I translate that to the human body?”

Despite a constant push by police, EMS, and the county’s heroin task force to raise awareness and practice proper response, Sammarco estimates overdose deaths will reach close to 500 by year’s end—which would be another grim milestone. The only solace is the belief that there’s nothing stronger lurking.

“Hopefully,” says Glassman, “we’re as deadly as we can get right now.”

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