The Brutal Business Of Heroin Brings Wave Of Overdoses In Pa.

According to state and local authorities, 22 people in Western Pennsylvania have died of heroin overdose in less than two weeks. The wave of deaths is due to the appearance of an especially potent batch of heroin, mixed with the painkiller Fentanyl. NPR's Arun Rath speaks with Dr. Neil Capretto, medical director of the Gateway Rehabilitation Center in Pittsburgh.

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ARUN RATH, HOST:

Drug-related deaths are scarring families and communities across the country. The area around Pittsburgh, Pennsylvania, has been hit especially hard. Twenty-two people have died there in less than two weeks, the latest in a wave of heroin overdoses. Police in Western Pennsylvania are blaming the deaths on an especially potent form of the street drug. After testing, they determined the heroin had been mixed with a prescription painkiller known as Fentanyl.

DR. NEIL CAPRETTO: Fentanyl is very potent. It can be 70 to 100 times more powerful than morphine.

RATH: That's Dr. Neil Capretto. He's the medical director at the Gateway Rehabilitation Center in Pittsburgh. He says dealers have stamped the drug with a street name Theraflu. Dr. Capretto says that is no accident.

CAPRETTO: Well, what does the product Theraflu treat? Flu symptoms, cold symptoms. What does going through opium or heroin withdrawal feel like? It feels like a very bad case of the flu multiplied times 10. They call it dope sickness. So it's basically marketing. We will treat your withdrawal symptoms if you're, quote, "dope sick" with this Theraflu.

You know, drug dealers compete with one another to get new customers. At first, it may not seem to make sense, why would they now have this product so potent that some of their customers are dying? Isn't it bad for business? But as some of my patients told me, a dealer may be willing to lose four or five customers through an overdose death to attract, you know, 30 or 40 new customers. And they call that the class of doing business.

When people start hearing of people dying from overdoses, logic would say stay away from that stuff. It's dangerous. People with addiction hear it and - particularly heroin addiction - and they think, that's the strong stuff. That's the good stuff. And they chase it. And, of course, they don't want to die. They think, I'm going to use it. I want to push the high to the edge, and I'm going to be more careful than the last person who died. But they very well may be the next person who dies.

RATH: Do you have a sense of why this drug is hitting the streets now in your area?

CAPRETTO: Well, first of all, we have an epidemic of heroin in Western Pennsylvania. And this is true in a lot of cities throughout the country. There's more heroin being used than at any time in our history. I mean, historically, heroin used to be thought of as mainly an inner city drug. That has dramatically changed, particularly over the last 10 years. Heroin now, at least in our area, is in every town community. It's become more of a drug of middle, upper middle-class Caucasian families.

And a lot of this has been fueled by the prescription medicine epidemic. I call this the perfect storm. We started in the late '90s with a big emphasis on better treatment of pain, which we absolutely have to treat. But that fueled physicians starting to write much larger amounts of pain medicines. I've treated - myself - thousands of people addicted to OxyContin and similar drugs.

What ends up happening, these people from the small towns to rural communities, they can no longer afford their prescription medicines. And then somebody tells them, hey, you can keep yourself from getting sick or get a similar feeling with this new heroin that started coming out. Then they became new heroin customers.

RATH: As we've been covering this new rise of heroin on this program, we've come across advocates who have called for states to pass what they call Good Samaritan laws so that people who call in when there's an overdose don't risk being arrested themselves. Does Pennsylvania have that law?

CAPRETTO: We do not. We are trying to get one. They're a very good idea. The sad thing is the majority of people who die from a drug overdose, there's somebody with them, and in the majority of cases, people do not call 911 because they're afraid if authorities come that they'll get arrested because they're also using drugs. The Good Samaritan law will say if you call in good faith, you will not be arrested for just simply using or have drug paraphernalia. There's legislation pending in Pennsylvania. I really think it should be a national standard.

RATH: Do you think you've seen the worse of the heroin epidemic in your area?

CAPRETTO: Unfortunately no. We've had an epidemic. I mean, this has been building up since the mid to late '90s. You know, in Allegheny County, Pittsburgh area, through the 1980s, we averaged around 55, 58 drug overdose deaths a year. That's a lot of people. In 2012, the last year we have statistics, we set a record of 288 drug overdose deaths. And unfortunately, I still see this as getting worse before it gets better.

I mean, this Theraflu thing is a crisis, but we've had a crisis. This is just a kind of spike upward in a crisis that's been ongoing. If the Theraflu goes away, we still have a major problem with heroin and prescription drugs in our community, and we can't forget that.

RATH: That's Dr. Neil Capretto. He's the medical director at Gateway Rehabilitation Center in Pittsburgh. Dr. Capretto, thank you.

CAPRETTO: Thank you very much.

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