Amber Mellen was a newlywed when her soldier husband was killed in Iraq. Just 18 years old, she turned to pain pills to dull the grief.
But Mellen got hooked on the drugs and spiraled into addiction. Before long, she was shooting up heroin.
“It was so easy to get, and so many people are doing it,” said the Olympia resident. “People who you see in the grocery store, people you would never expect are using it.”
New data from the University of Washington show that Mellen’s experience is far from unique. Heroin use among young adults in Washington is soaring, particularly in rural and suburban areas where treatment and counseling can be hard to come by.
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Last year, heroin was the leading reason people ages 18 to 29 sought treatment for substance abuse, far surpassing admissions for alcohol, methamphetamine or prescription drugs. The number of young people admitted for heroin treatment has more than quadrupled since 2007.
Overdose-death rates in counties like Cowlitz, near the Columbia River, and Clallam, on the Olympic Peninsula, now far exceed those in urban King County.
“Heroin is spreading across the state, and it’s spreading to young adults,” said Caleb Banta-Green, of the UW’s Alcohol and Drug Abuse Institute.
Experts believe many drug users are turning to heroin because recent rules have made it harder to get prescription painkillers like oxycodone. Drug cartels have rushed to fill the gap with Mexican black tar and other forms of heroin, which can sell for as little as $20 a dose.
Ninety-nine people died from heroin overdoses in King County last year, more than double the number in 2009. Most of the increase came in the under-30 age group.
“You’re not supposed to die in your 20s,” Banta-Green said.
The statewide trend is similar. While overdose deaths linked to prescription pain pills dropped by more than one-quarter between 2008 and 2013, heroin-related deaths increased by more than half, to 227 last year.
Yet many doctors remain reluctant to prescribe a medication that can help some patients overcome addiction without having to travel to a methadone clinic every day.
About 450 doctors in Washington are certified to prescribe buprenorphine (byoo-pruh-NOR-feen), marketed under the name Suboxone, for addiction treatment. But an analysis published earlier this year found that fewer than a third of certified physicians surveyed were actually giving patients the drug.
Many doctors who don’t prescribe buprenorphine said they were wary of working with addicts without a more robust system of counseling and social assistance.
“It’s really a crisis,” said Dr. Roger Rosenblatt, an author of the study and associate director of the UW’s Rural/Underserved Opportunities Program. “People are suffering, people are dying, and we have the therapy for it.”
Only 10 to 20 percent of people who need some form of addiction treatment are getting it, said Dr. Charissa Fotinos, deputy chief medical officer for the Washington State Health Care Authority.
Like methadone, “bupe,” as it is sometimes called, blocks symptoms of withdrawal and craving, and it helps users avoid the temptation to relapse. The risk of overdosing on bupe is much lower than on methadone. And while methadone must be administered at a clinic, bupe can be prescribed for use at home.
That’s particularly helpful for young adults, who may be facing years of treatment while juggling school, work and families, Banta-Green said. Rural residents also can benefit significantly, because most of the state’s methadone clinics are in urban areas.
“Getting to a methadone clinic every day can be a pain in the butt for a lot of people,” he said.
By the time Mellen decided to seek treatment, she had been shooting up for three years. “I was the worst of the worst,” she said. “At the end, I was on the street.”
She tried methadone, but it put her into a stupor. Suboxone eased the gnawing desire for heroin, and helped clear her head.
“It made me myself again,” she said.
Now 26, Mellen has been on the medication for two years. She gets it from Dr. Lucinda Grande, a primary-care physician in Olympia. With a long-standing interest in chronic pain and drug abuse, Grande was eager to take the eight-hour class required of all doctors who want to prescribe buprenorphine for addiction. Some of her patients come from as far away as Longview because they can’t find anyone close to home who prescribes the medication.
Grande often has to turn patients away. “I just feel so guilty because somebody might be a good candidate, and they really need this drug, but I can’t take them.”
The Affordable Care Act, or Obamacare, requires Medicaid and most private insurance to cover substance-abuse treatment. That includes buprenorphine, which can cost $300 a month or more.
But many physicians aren’t keen to work with addicts or add a new type of treatment to their already-busy practices. None of Grande’s five partners at Pioneer Family Practice opted to prescribe buprenorphine.
“It’s a very demanding group of patients,” said Dr. Edward Cates, one of those partners. Cates also worries that the benefits of the medication have been overblown.
Clinical trials show that buprenorphine is slightly less effective than methadone in eliminating opioid abuse. Like methadone, it can also be dangerous.
The drug is an opioid and can generate a high in people who aren’t regular users. It has become part of the illegal drug market — diverted by unscrupulous patients and purchased by recreational drug users and addicts who can’t get a prescription. Buprenorphine has also been linked to several hundred overdose deaths nationwide — including a few in King County. In most cases, though, the victims had ingested several different drugs.
“I’m not trying to undersell its risks,” Banta-Green said. “But I personally don’t have any doubts that the benefits outweigh the risks.”
Grande, who accepts only highly motivated patients, said it’s rewarding to see people improve so dramatically.
“Buprenorphine doesn’t work for everyone, but for the majority of patients I see, it is literally a lifesaver,” she said.
That includes Ian, a 30-year-old Pierce County man who didn’t want to disclose his last name because of the stigma associated with heroin.
Addiction runs in his family, he said. His first taste was in high school, when we was prescribed Vicodin after a football injury. By the time he started taking Suboxone about a year ago, Ian was homeless and out of work.
“I didn’t have anything but the clothes on my back.”
Today he has a job, a car, a house — and the ability to feel joy and happiness again. “I’ve experienced a level of normalcy I didn’t think possible for me,” he said. “I know the challenges I still face on a day-to-day basis, but to me, it’s a miracle drug.”
Addiction is a chronic, relapsing condition, and many people have to go through multiple cycles of treatment before it sticks, Banta-Green said. But decades of studies show that maintenance medication, like methadone and buprenorphine, is the most powerful tool available to help users stay off heroin and related drugs.
Every dollar spent on treatment saves the government more than $7 that would otherwise be spent on medical care, drug-related crime and incarceration, said Jim Vollendroff, director of King County’s Mental Health and Substance Abuse Division.
Washington is working to expand the availability of buprenorphine treatment by lifting several restrictions on Medicaid coverage, including one that limits treatment to 12 months, said Fotinos, the medical official at the state Health Care Authority, which oversees the Medicaid program.
“For many people it’s like methadone,” she said. “They may need it for the rest of their lives.”
Fotinos and her colleagues are also looking for ways to recruit more doctors to prescribe the drug, such as reducing the amount of paperwork involved.
Meanwhile, health experts also hope to raise awareness of an antidote that could reduce the number of overdose deaths in the state if administered quickly.
Called naloxone, or Narcan, the drug can save people who take too much heroin or methadone or an overdose of prescription pain pills.
Some ambulance crews carry the drug, and several pharmacies around the state stock a nasal-spray version. It’s available without a doctor’s visit to opiate users and their friends and families.
Sandi Doughton: 206-464-2491 or firstname.lastname@example.org