DOCTOR: HEROIN USE NOW EPIDEMIC

Murder One.

Boy On.

Brain Damage.

Lightning.

They are simple words with potentially deadly meanings.

They are brand names, often in pink, stamped on heroin packets that have
appeared in western Pennsylvania.

And some of these "glassine" packets - or others like them - have led to
deaths: more than 70 total in Allegheny, Westmoreland and Butler counties
this year.

"I would say, in my opinion, heroin use is on the rise and could be
considered an epidemic," said Dr. Robert Woolhandler, a Pittsburgh drug
addiction specialist.

"Its use is skyrocketing among kids: college students, school kids, younger
kids. I'd call it an epidemic."

Several reasons are responsible. Heroin's price is down, while the street
costs for other drugs such as the painkiller OxyContin are up. Heroin is
available. And it's easy to use, with many snorting the drug rather than
injecting it, at least initially.

"You go for the cheaper commodity. - It usually becomes an economic
decision," Woolhandler said about a user's choice of drugs.

Latrobe police Detective Ray Dupilka said a glassine packet - a small
wax-paper envelope often blue or white in color with a fraction of a gram
of heroin inside - sells for between $20 and $30 in Westmoreland County. In
Pittsburgh, from which much of the heroin in western Pennsylvania comes,
the same packet could sell for $10, he said.

A 40-milligram tablet of OxyContin can be bought on the streets for between
$30 and $40, Westmoreland County Detective Tony Marcocci said.

"Two years ago, to come across heroin was rare. Now, more often than not,
we're finding with these drug users that's the drug of choice," Dupilka said.

Hard-core heroin users can consume about 10 packets per day, police sources
said.

"We're seeing more and more people using and selling despite our efforts to
stop it," Marcocci said.

David McAdoo, Fayette County Drug and Alcohol Commission executive
director, said for some reason people find snorting heroin to be less
objectionable than injecting the drug. But either way, it's harmful, he said.

"It's just as addictive (snorting heroin) because you're still getting it
into your body," McAdoo said. "(Snorting) also is, for a lot of people, a
silent introduction."

So far this year, Allegheny County has had 47 deaths in which heroin was
present in the body, while Butler County has recorded 23 heroin- related
deaths and Westmoreland County has seven confirmed deaths related to the
drug and possibly an eighth last month in Greensburg. Officials are
awaiting test results in that eighth case.

The Allegheny County Coroner's Office determined that heroin was present in
73 percent of the 180 deaths determined to be from accidental drug
overdoses in 2001. Of that total, 49 deaths resulted from heroin alone,
while 131 others stemmed from a combination of heroin and at least one
other drug, according to the report "Accidental Drug Overdose Deaths 2001."

ACCIDENTAL DEATHS

Woolhandler, who also serves as a consultant for the Fayette County drug
agency, said most heroin-caused deaths are accidental and result from
breathing suppression.

He said three reasons typically are responsible for heroin deaths: using a
concentration of the drug stronger than the user is accustomed to;
positioning of the body after drug use; and "pushing the envelope to get a
little higher."

Some experts believe a person can become psychologically addicted to heroin
with as few as three or four uses. Physical addiction takes longer.

"I would say that would take a good month or two of daily usage," said
Woolhandler, who is medical consultant to Gateway Rehabilitation Center's
Braddock clinic in Allegheny County as well as medical director of Renewal
Inc., a downtown Pittsburgh inpatient drug treatment facility.

Getting off heroin is difficult.

"It's very hard," Woolhandler said. "They have to be very willing and very
motivated. The motivation level has to be very high. It's not easy. - I
would say, in my opinion, the hardest withdrawal I've seen is with the
opiates."

Once a person is clean, "you can't use opiates again," he said. "The only
treatments are abstinence or going on methadone."

McAdoo agreed that stopping heroin use is hard.

"One of the complications is the physical dependence," he said. "And it is
one of the ones where we see the highest incident of failure in our
traditional treatments."

Woolhandler uses other drugs at his Pittsburgh facility to try to lessen
the side effects for a person withdrawing from heroin. He said the effects
are greatest the first two weeks or so of withdrawal. Then other medical
and spiritual methods are used to try to help the user stay clean.

Chad Johnston, a treatment specialist with The Open Door, an outpatient
facility in Indiana County, estimated it would take a motivated hard-core
heroin user six months to one year to get off the drug. Many users fail in
this effort.

"To be honest with you, (the relapse rate) is high," Johnston said.

Unlike Westmoreland, Allegheny and Butler counties, neighboring Fayette and
Indiana counties have recorded no deaths in 2002 related to heroin,
according to coroners' offices in those counties.

"Not this year," Indiana Coroner Tom Streams said earlier this month. "I
had some last year."

Indiana County had three deaths caused by other drugs from Jan. 1 to the
beginning of this month, and the Fayette County Coroner's Office reported
four fatalities resulting from other drugs.

But the lack of heroin-related deaths in 2002 in Indiana and Fayette
doesn't mean the substance isn't present in those counties.

"We've found a slight increase with heroin," Johnston said. "A lot of it
was with OxyContin - which also seems to be on the rise. There just seems
to be more of a supply in the area. I think opiates, altogether, are on the
rise."

GATEWAY DRUG

Marcocci describes OxyContin as a "gateway drug" to heroin, with many
heroin addicts former OxyContin users.

McAdoo said heroin is present in Fayette County, too.

"We're hearing a lot of anecdotal reports," he said. "We're not seeing a
significant shift (in number of clients on heroin) - but we're hearing of
its increased use from our clients and from our police forces."

McAdoo said the delay in seeing heroin's use in patient numbers could
result because of the time that passes between arrests and sentencing of
heroin offenders to treatment programs. It also can take a while before the
effects of heroin consumption are apparent in a user's daily life, he said.

Some of the heroin in Fayette County is 94 percent or more pure and is
coming from central Pennsylvania, the executive director said.

"This is what we're being told from our counterparts in other counties.
It's coming this way," McAdoo said.

Marcocci, a Westmoreland County detective for 23 years, said heroin's
presence is strong in Greensburg as well as Latrobe and its surrounding
communities. One death and possibly another from the drug occurred in
Greensburg this year, according to the coroner's office. And four others
involved Derry Township residents.

"Do I necessarily know why? No," Dupilka said of the drug's availability in
and around Latrobe. "But there's definitely an increase of narcotic use,
opiate-derivative use out this way. And we've seen it in other areas of the
county."

"All kinds of people," Marcocci said in describing heroin users. "We see
people from various socioeconomic classes - career people. And the sad
thing is, typically the use is hidden until it's too late."

Besides the threat of death, heroin use can lead to other offenses.
Property crimes can increase because of the user's need for immediate cash.

"That's what I would term indicative of heroin use: the thefts, the bad
checks, the stolen property. Anything to get quick money," Dupilka said.
"When we're investigating bad checks - we've often found heroin is the
underlying cause."

Officials in Lewistown, a borough of about 10,000 people in central
Pennsylvania, blamed a heroin problem for a 400 percent increase in
criminal activity a few years ago.

Woolhandler and Johnston said drugs also run in cycles: cocaine, crack
cocaine, OxyContin, heroin.

"There's always something out there," Woolhandler said.