Heroin addiction has its stereotypes: The homeless junkie jonesing for a fix, or the '80s rock star found dead in a hotel room with a needle in his arm.
But police and federal agents say the face of heroin — nationally and in Omaha — has changed. Heroin users in 2016 often are well-off suburbanites who get hooked on prescription painkillers and resort to heroin because it's cheaper and easier to get than pain pills.
"The new heroin user is someone with means, who can hide it for a while and isn't standing on a street corner," said Sgt. Dave Bianchi, a narcotics detective with the Omaha Police Department. "You see these people and say, 'How in the world are you using heroin?' The heroin user of this millennium is not the heroin user of the last millennium."
Heroin use in the U.S. more than doubled between 2007 and 2013, according to a report released last year by the Centers for Disease Control and Prevention. President Barack Obama has made addressing the problem a priority. His 2017 budget proposal included a request for $1 billion to fight what is considered a heroin epidemic.
In Omaha, Bianchi said he has come across more cases involving heroin in the last three or four years than he had in two decades on the job.
For years, the Omaha police came across 10 or so heroin dealers who probably had six or seven clients each, Bianchi said. That added up to roughly 70 addicts at any given time.
"Our heroin community was very small," he said. "It was the same people, the same users and dealers."
Now, Bianchi said he's convinced that the number of addicts in the city is triple that.
"Everybody gives the same story," he said. "They started abusing painkillers."
For a Bellevue man, a prescription for pain pills nine years ago led to a full-blown heroin addiction that he still struggles with today.
Jeremy, a married, 28-year-old father of two, started taking oxycodone and Percocet under a doctor's care to ease the pain of osteomyelitis — a rare and painful bone infection — in his chest. After a year, a pill addiction had set in.
Once the osteomyelitis had been treated, Jeremy said, his doctor cut him off cold turkey. Jeremy, who spoke to The World-Herald on the condition that only his first name be used, started buying painkillers on the street. Within a year and a half, he was shooting up heroin.
"The first time I used, I thought, 'I can't believe I'm about to do this,' " Jeremy said. "But I was sick, going through withdrawal, and to be honest, I just didn't care."
The connection between prescription painkiller addiction and subsequent heroin use is concerning to medical professionals, who say the number of addicts they're treating has increased.
Joan McVoy, a nurse with the Nebraska Regional Poison Center, said many people are buying heroin on the street to satisfy what started out as an addiction to oxycodone, Percocet (a combination of acetaminophen and oxycodone) or hydrocodone. They often start taking pain pills after an injury or surgery, she said.
Hydrocodone, oxycodone and heroin all are opioids and offer the same kind of high. On the street, hydrocodone and oxycodone are pricy — one 10 mg pill of oxycodone, for instance, can cost $10, McVoy said.
Jeremy said he usually took eight pills at once to feel "normal," and he would need to do that two or three times a day. In all, he figures that back then, he was spending between $150 and $200 per day on pain pills bought on the street.
A $5 bag of heroin, on the other hand, is good for several doses. Jeremy said it lasted him all day.
Bianchi, the narcotics detective, said heroin is an almost instantly addictive drug that most people find difficult to kick. (That can be the case even when someone is being treated with methadone.) Heroin withdrawal, he said, has major physical and mental symptoms that most people find unbearable.
"You feel like your skin is crawling, guts are wrenching, joints are tearing apart," Jeremy said. "Plus vomiting and diarrhea. You'll do anything to make it stop."
Bianchi said addiction and fear of withdrawal keeps most addicts using until they die or go to jail.
"People who have been clean six or seven years still feel a pull to it," he said. "Heroin ruins everything it touches."
Nationally, about 30,000 people die of heroin overdoses each year. According to the Nebraska Department of Health and Human Services, the state had recorded one heroin-related death in 2006. In 2014, the most recent year for which figures were available, six people in Nebraska died of heroin overdoses.
"The end result, always and eventually, is death," Bianchi said.
Heroin is even more dangerous when it's laced or cut with the drug fentanyl, McVoy and Bianchi said. Fentanyl, which is used medically to sedate patients for surgery and to alleviate severe pain, is 50 times more powerful than street heroin and 100 times stronger than prescription morphine. The risk of overdose and death is so high that the CDC issued a health alert late last year, warning drug users of the potentially fatal outcome.
"People just don't know what they are getting," McVoy said. "There are bad batches of heroin out there. It's very dangerous."
Added Bianchi, who works undercover and frequently buys drugs on the job: "We have gone to heroin dealers who said they had heroin. We took it to the lab and found out it was fentanyl."
Getting caught with heroin is a serious offense. In Nebraska, possession of even a tiny amount of heroin is a class 4 felony, punishable by up to two years in prison, a $10,000 fine or both.
Undercover federal agents are buying more of the drug and launching subsequent investigations into bigger heroin operations, said Zac Cherrington, a supervisory special agent with the U.S. Drug Enforcement Administration in Nebraska.
"It's been here for a long time but just in small quantities, small pockets," Cherrington said. "I"m confident that our arrest numbers are going to increase."
The stigma around heroin seems to have diminished, Cherrington said.
"We are getting used to seeing people doing things they never thought they would do," he said. "They have college degrees, hold a full-time job and are out on their lunch breaks buying heroin."
Added Deanne O'Flaherty, the program manager of the Omaha Treatment Center, a southwest Omaha methadone clinic: "We see people from all walks of life. Addiction doesn't discriminate."
Jeremy was sober for two years but relapsed when he and his wife separated. He is clean again, going on five months now. He said he's working construction and rebuilding his marriage.
He is undergoing methadone treatment, which eases heroin withdrawal, and hopes to kick the habit for good.
"When I was by myself, lonely and depressed, I would use heroin and then feel nothing," Jeremy said. "It takes you to a place where you can be numb."
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