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Coping With Heroin Crisis

by on June 01, 2014 11:45 AM

Every Sunday evening, a group of young women get together in the Boalsburg home of psychologist Dr. Jennifer Harp.

They’re there for the weekly meeting of the Order of Elizabeth, a community group that Harp and Jill Loomis, a social worker in State College, started shortly after the tragic and untimely passing of 21-year-old Elizabeth (Lizzie) Smeltzer from a heroin overdose on January 25.

The group was organized in order to help Smeltzer’s friends (Harp and Loomis included) cope with the pain and confusion surrounding her death.

The group is named in honor and in memory of Lizzie.

“When Lizzie died, my heart was hurting and I needed help understanding what had happened,” Harp says. “I had a sense that Lizzie’s friends were courageous and loyal, but that they, too, were shell-shocked by the loss. We all needed to figure out how this might have happened. We all needed to heal.”

More than anything else, though, Harp and Loomis felt a strong need to take a stand in the community and counter the “dark forces” surrounding Smeltzer’s death with “something more positive.”

What exactly that “something” is, Harp can’t quite say, but, every week since its inception, more and more young women — some of whom never even knew Lizzie Smeltzer — are coming to Order of Elizabeth meetings, hoping to find the support, empathy, and direction they need to contend with the dark forces that may be complicating their young lives within the context of the State College community drug scene.

“Lizzie’s death has highlighted the fact that heroin addiction can affect just about anyone, no matter their age, family background, or socio-economic status, and regardless of what sort of community they may live in,” Harp says. Today, heroin addiction and its often unfortunate consequences are affecting communities across the United States.

Centre County — State College and other towns — is no exception. In 2013, the Centre County Coroner’s office reported 10 heroin-related deaths, compared with three in 2012. The numbers are clocking in this year, too, as stories of drug busts continue to make headlines in tandem with what’s become a national concern.

Heroin: Old drug, new avatar

There’s nothing new about heroin, of course. It’s been around for as long as most of us can remember, and through the decades the supply/demand dynamics of heroin have ebbed and flowed.

But what’s both different and particularly alarming today is that heroin is not only readily available, it’s also extremely cheap, selling on the street for around $25 a bag, according to Terry Stec, school-resource officer for State College Area High School.

Considering that a typical addict uses three to four bags of heroin a day, that price tag is pretty attractive, Stec says, particularly when compared to prescription drugs, which also are widely abused but are priced on the black market at around $90 for a single, 80-milligram pill.

Because it’s so cheap and, apparently, so easy to access, heroin has become the drug of choice for many young people in the community (although Stec clearly states that he has not seen any confirmed cases of heroin use by State College High School students, and if there’s any drug used by them, it’s marijuana).

Heroin, in Stec’s view, is more likely to be used by those who can’t get the high they seek from marijuana or other, softer drugs, than by first-time, experimenting users.

However, many youngsters also are chasing after prescription painkillers such as Oxycodone and Vicodin, and will do what they can to get them, including shopping around for doctors from whom they hope to get prescriptions.

This makes things very difficult for medical practioners such as Amit Mehta, MD/MRCGP at Geisinger in Williamsport, who says the hardest question doctors face on a daily basis is whether a patient is genuinely in need of painkillers or just trying to pull the wool over their eyes. “The foremost issue in my mind each time a patient comes in saying they’re in pain and they want medication is the fear of abuse,” Mehta says. “As primary-care doctors, we’re the first port of call, and the greatest dilemma we face is being able to distinguish between true pain and false pain, between pain that requires prescription painkillers and pain that doesn’t even exist.”

Even after running a battery of tests on a particular patient, the decision on whether to prescribe pain medication is ultimately based on pure “clinical judgment,” Mehta says. Every physician’s intent is to “do no harm and help each patient in the most ethical and empathetic way possible,” but sometimes a doctor can get it wrong.

But that doesn’t mean that there aren’t patients out there, both young and old, who genuinely need strong pain medication.

Even as it’s getting more common for people to try and wrangle prescriptions for strong painkillers from primary-care physicians (either for their own use or to sell on the black market), “there are a lot of patients with true clinical pain who need narcotic prescriptions for better pain control,” Mehta says.

Failure to get the pills they need can then lead to a desperate quest for a substitute. In many cases today, that’s heroin, because it’s so cheap and readily available, and like prescription painkillers, it’s an opiate. But those who come to heroin addiction in this way are in as much danger as any other heroin user because the composition of heroin has changed dramatically in recent times.

There is no good heroin, of course, says Cathy Arbogast, program manager at Centre County’s Drug and Alcohol Office, but, today, the heroin that’s flooding small communities across the US and is being sold on the streets of Centre County’s towns is doctored with all kinds of substances — corn flour, baking soda, and baby powder, not to mention dangerous and highly toxic chemicals — “so you just don’t know what you’re getting,” she says.

Heroin dealers in Centre County also have stopped labeling their bags, Stec adds, which makes things even more dangerous, since “you don’t know who’s selling the stuff and what they’re cutting it with.”

Heroin has always been one of the most dangerous drugs out there. Today, it’s become even more dangerous, Arbogast says, and because users do not know what’s in it and are unaware of its potency, incidences of accidental overdose, such as the one that claimed Lizzie Smeltzer, have significantly increased.

Stronger than any other force

The night she died, Lizzie Smeltzer had prepared dinner for her family — a new dish, her mother, Bonnie Kline Smeltzer, pastor at University Baptist & Brethren Church in downtown State College, says, since Lizzie loved to cook and was constantly experimenting with recipes — and they’d all shared a great meal. There was no way the Smeltzers could have known that when Lizzie left the house later that night (she told her parents she was going to a party with a friend), they would never see her alive again.

The Smeltzers describe their daughter as a kind and compassionate young woman, a popular girl with lots of friends and eclectic interests, who was always willing to reach out and help the underdog. She faced many of the “typical young-adult issues” that so many her age face, Bonnie Smeltzer says, and studies were not her forte. But “we were always supportive of Lizzie and encouraged her to pursue her interests and consider other types of careers,” Bonnie says.

Her parents knew that Lizzie, like others her age, had dabbled in pot in high school. However, they only found out about her heroin usage (she got into heroin only after graduating from State High) when they received a phone call from the police in May 2011 informing them that their daughter had overdosed.

Naturally, they were stunned.

Lizzie, too, was undoubtedly rattled by the trauma of that experience, her father, Ken, says. Although she never wanted to discuss her heroin use with her family, Lizzie did go through a classic drug detox and rehabilitation program, and attended post-rehab therapy. She was on Suboxone (a prescription drug used to treat opiate addictions) for almost two years, but weaned herself off it because she didn’t like how it made her feel and didn’t like being addicted to it (the long-term use of opiate replacements such as Suboxone and Methadone is a highly controversial issue). It also cost $70 per week for the doctor and more for the drug.

The Smeltzers aren’t sure when or why Lizzie again got into heroin. Looking back, they don’t recall any red flags and they can’t think of any significant changes in her behavior.

What they are convinced of is that that she definitely didn’t set out to die on the night of her overdose. Like so many others, the potency of the drug got the better of Lizzie, underscoring the fact that from heroin there is very little escape, if any at all.

“Through my years of addiction, I’ve had several friends either pass away due to accidental overdose, intentional overdose, or drug-related accidents,” says 22-year-old Jane (her name has been changed for the purposes of this article), who battled a heroin addiction for several years. “I’ve also seen people go to prison and get very long sentences because of their history of drugs. Either way, I’ve seen it take a lot of peoples’ lives away from them.”

Now, as they look back and try to find the answers to the terrible tragedy that’s occurred in their family, the Smeltzers believe they were ignorant of the dangers of heroin, and only now are they truly aware of the extent to which their daughter, like so many others her age, sought the thrill of a high — heroin being the ultimate high.

“Lizzie liked to walk on the wild and tough side,” Ken Smeltzer says, “and she also thought she was invincible, that nothing would ever happen to her.”

That’s exactly how many young people feel, says 22-year-old Audrey (her name has been changed for this article), who spent four years addicted to heroin.

“I was curious about heroin. I wanted to try it and I didn’t think anything really dangerous could happen to me,” she says. “But I think there’s a tipping point from where it very quickly goes from experimentation to becoming a full-blown addiction, and I don’t know a person who’s done heroin and not become addicted. Once someone starts doing heroin, they probably don’t stop doing it.”

Toward a more understanding society

Lizzie is gone, and for her parents and for many other parents across America who have lost their loved ones to heroin, life will never be the same again. But as the grim realities of heroin addiction become more widespread, society cannot afford to give up.

On the contrary, says Arbogast, there’s an even greater duty today in working to figure out ways to both understand and treat addictions. The supply of heroin is a given, but our community, like any other, needs to foster a more tolerant and accepting culture that, in a first instance, tries to figure out the underlying reasons people might turn to a substance such as heroin, and then supports addicts and recovering addicts in a holistic and nonjudgmental manner.

“Addiction is a chronic disease that, like any other, knows no racial or socio-economic boundaries, and yet we don’t stigmatize chronic diseases the way we stigmatize addiction,” Arbogast says.

As part of its effort, the Drug and Alcohol Office has formulated outreach programs to make youngsters feel both confident and positive about themselves, Arbogast says, and it also has programs that take into account the penchant for thrills and experimentation that’s common in so many youngsters who turn to substances, “so that they can get that high without drugs or alcohol.”

At State College High School, principal Scott Deshong places a great deal of importance on education and prevention. He believes in reaching out to those students who may be dabbling in drugs, and connecting with their families, informing them of what may be going on in their children’s lives and offering up support. Rather than policing, he believes in empathy and understanding for youngsters who may be falling through the cracks, because “although we may not be seeing heroin addiction here, we would rather provide the necessary support to kids that may be facing problems to avoid a worse situation two or three years down the road,” he says.

But perhaps the most important ingredient in fostering a more understanding society is instilling a sense of self-worth, through compassion and kindness, in both addicts and recovering addicts. That’s what was missing for Jane and what she has finally found with joining the work of the Order of Elizabeth.

“Here, I’m not labeled as an addict, which I hate — I’m not judged,” she says. “I had been to so many Alcoholics Anonymous and Narcotics Anonymous meetings, but when I came across this organization on Facebook, I immediately felt a connection, because we’re approaching [the issue of addiction] through the heart.”

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Savita Iyer is a freelance journalist who moved with her family to State College in August. She has worked as a full-time business journalist in New York, and, as a freelancer, has reported from both Europe and Asia. Her features on a variety of top- ics have appeared in many publications, including Business Week, Vogue (Mumbai, India edition), and on CNN.com.
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