Whether injected, snorted or smoked, heroin is rapidly delivered to the brain. The euphoria is immediate, and after just a few times of using, people can become addicted. Washington state is experiencing an opioid abuse and overdose crisis, and the San Juan Islands are not immune.

“There is rampant drug use here, and it is with kids who were born and raised on this island,” said Orcas resident Vala Ross. “These are high-functioning drug users who are members of our community.”

Ross is the assistant director of Kaleidoscope Pre-School and a member of a county work group tasked with addressing substance abuse. She has intimate knowledge of the heroin community, and says it’s a local epidemic. Ross has heard that the drug is purchased in Friday Harbor, Mt. Vernon and Seattle.

A 2015 University of Washington study compared data from 2002-2004 to 2011-13 to show opiate trends in the state. There was a 197 percent increase state-wide of publicly funded drug treatment admissions, and for San Juan County, 90 to 180 patients were admitted into a public treatment program. Previously, there were fewer than 45. Neighboring Whatcom County had more than 360 patients admitted into a treatment program; previously it had 90 to 180.

“Word on the street is that it’s on the rise here, but I don’t have any data on that,” said Barbara LaBrash, human services manager for San Juan County. “The conversation needs to be constructive and not fear-based. I’ve heard other counties say that it’s a problem too, and they are trying to address the opiate epidemic for larger communities along the I-5 corridor.”

Approximately 600 people die each year in Washington from opioid overdose with an increasing proportion of those deaths involving heroin, according to the state department of health. The largest increase in heroin overdose deaths from 2004 to 2014 occurred among younger people ages 15 to 34 years.

State government agencies, local health departments and community organizations across Washington have been building networks to reduce mortality associated with opioids. The 2016 Washington State Interagency Opioid Working Plan has four goals: prevent opioid misuse and abuse; treat opioid abuse and dependence; prevent deaths from overdose; use data to detect opioid misuse/abuse, monitor mortality, and evaluate interventions.

Ellen Wilcox, manager of the county health department, says San Juan County’s heroin abuse and overdose numbers are less than other, larger regions in the state.

“But that is not to say that we should ignore it. We are paying attention,” she said.

How it starts

A key component of why people start abusing any substance – whether it’s alcohol or drugs – is to self-medicate. And for many heroin users, it starts with prescription painkillers like Vicodin, Codeine, Percocet and Oxycontin. Heroin is a cheaper and more accessible way to achieve a similar feeling of euphoria.

“These are people who feel so bad that they want to feel nothing,” said Ross.

According to a DOH statewide survey of syringe exchange clients, 57 percent of those who inject heroin said they were hooked on prescription opiates first. The National Institute on Drug Abuse says Oxycontin and Vicodin are “currently among the most commonly abused drugs in the United States. Research now suggests that abuse of these drugs may open the door to heroin abuse.”

“They don’t know how to cope with a life not on drugs,” Ross said. “They use for years and think they have control, and then suddenly it slips away.”

Heroin is an opioid drug taken from morphine, which is extracted from the seed pod of the Asian opium poppy plant. Upon entering the brain, heroin is converted back to morphine, which binds to opioid receptors, producing a surge of intense pleasure. Users feel a rush of happiness and warmth and for several hours feel as though time has slowed down. Some people become so relaxed that they nod off or have slurred speech. With repeated use the body will no longer produce its own chemicals for pleasure or to relieve pain.

Heroin is usually a white or brown powder or a black sticky substance. The drug can be snorted, smoked or injected. Heroin use can lead to collapsed veins, infections of the heart lining, skin infections, contracting HIV/AIDS, hepatitis B and hepatitis C, lung disease and miscarriage.

“We don’t have a needle exchange program here so that opens up a whole other world of problems,” Ross said. “In the San Juans, no one treats it as a public health crisis. It’s treated as a criminal issue.”

Ross said addicts are often reluctant to seek help because of the potential for criminal charges.

San Juan County Sheriff Ron Krebs says the heroin cases he sees in San Juan County are two-fold: arrests made by deputies or EMS response to an overdose. The Sheriff’s Office makes one to two arrests per year involving heroin, and Krebs says it is usually predicated by an overdose.

“We aren’t seeing as many this past year, but it is still here and probably as strong as ever,” he said. “It’s tough to get a really good feel on the drug community unless you are making a massive number of arrests … I am not here to just arrest people. I am here to help people seek treatment.”

Both Krebs and LaBrash said the most significant substance abuse disorder they see is with alcohol.

“I see way more damage from alcohol abuse,” said LaBrash, referring to the number of people impacted, health consequences and quality of life.

Krebs said the second most common abuse is with prescription medications.

“With a lot of people we arrest, you almost need a pharmacology degree to understand all the medications they require,” he said. “The medications just mask their mental health problems. There are serious mental health or life issues that cause people turn to heroin. For thousands of years we’ve never been able to eradicate drug use from society.”

Krebs work closely with the local prevention coalitions, which strive to educate young people. His mantra is: “an ounce of prevention is worth a pound of cure.”

What’s being done?

Compass Health, which is based in Everett, provides mental health and chemical dependency services in San Juan, Island, Skagit, Snohomish and Whatcom counties. Assistance is offered on San Juan, Orcas and Lopez; the main local office is in Friday Harbor. To enroll in a program, call 378-2669. The 24-hour drug and alcohol helpline is 1-800-562-1240.

“Anecdotally, we are hearing that there is an increase in heroin usage in the county, but we haven’t seen that (increase) reflected in our caseloads – at least not yet,” said Compass Health Program Manager Barbara Starr.

The North Sound Behavioral Health Organization, which is based in Mt. Vernon, administers state and federal funds for mental health and substance abuse services for San Juan, Island, Skagit, Snohomish and Whatcom counties. They provide a regional system of crisis and treatment services through Compass Health. They also manage the 24-hour mental health crisis line at 1-800-584-3578.

There are two detox centers in Whatcom and Skagit counties. Locally, two medical facilities offer outpatient withdrawal treatment for heroin addiction: Orcas Family Health Center and Orcas Medical Center.

Dr. Anthony Giefer at the Orcas Medical Center began offering opiate treatment 10 years ago in response to islanders who were addicted to pain pills. He provides Suboxone (drug name buprenorphine) a prescription drug that limits withdrawal symptoms like vomiting, diarrhea, shaking, muscle spasms, depression and anxiety. The drug also decreases the frequency of cravings. The drug is usually taken for at least two years. He said Suboxone is far superior to methadone as a drug to treat opiate addiction – Suboxone is harder to abuse and less likely to cause an overdose.

Patients are required to take urine tests to ensure they are not using again, and are set up with counseling through Compass Health.

Since that first year, Giefer saw around 30 patients on an annual basis; in the last few years that number has increased to 45. There are currently 40 patients being treated at OMC for opiate addiction. As the price and availability of prescription opiates shifted, Giefer began to see primarily heroin addicts. A handful of his patients are from Orcas; the remainder are from San Juan Island and the mainland.

“There aren’t enough physicians on the mainland who do this so patients come from as far away as Anacortes, Blaine, Lynnwood and Bellingham,” Giefer said. “I have so many patients from San Juan Island. It’s incredible. And they say there are many, many more over there. I have wondered for years if people on Orcas don’t want to seek treatment locally or if there are fewer people on Orcas who are addicted.”

Those in search of help find OMC through word of mouth or the websites www.suboxone.com and www.naabt.com, which list physicians nearby who offer treatment. The medical center can be reached at 376-2561. For those without insurance, medicaid will pay for the cost of Suboxone treatment.

“I have some incredible success stories. I’ve had so many people turn their life around. Which is why I keep doing this,” he said. “And people would be surprised. There are plenty of contributing members of society who have an issue with these drugs.”

At Orcas Family Health Center, Dr. David Shinstrom also offers Suboxone treatment. Patients sign a contract agreeing to no early refills and taking urine drug screens throughout the treatment. Shinstrom also encourages his patients to join Narcotics Anonymous.

“You don’t want to put any barriers up for people to succeed,” he said.

Shinstrom said he feels strongly about offering heroin addiction treatment, particularly because not many clinics in the region provide that kind of service. He has been offering the treatment for seven years, and estimates he has treated 40 patients during that time.

“There is quite a bit of heroin on Orcas Island,” Shinstrom said. “It’s readily available … don’t put your head in the sand. And if we can help people get off of it, we will do that.”

OFHC had so many patients coming from Bellingham and Mt. Vernon that it has had to scale back the number of off-island participants. Shinstrom is currently overseeing a dozen patients on Suboxone. Most of his patients are from Orcas and San Juan Island. OFHC can be reached at 376-7778.

The substance abuse treatment center in Sedro-Wooley, which is the closest detox center for islanders, will be closing after 2018 when its lease is up. North Sound Behavioral Health Organization is looking at developing replacement programs. Representatives from the organization have held several brainstorming sessions in the San Juans this year, talking to mental health professionals, educators, doctors, juvenile probation officers and social workers.

As the assistant director of Kaleidoscope, Ross was asked to weigh in on the impact that drug use has on families and kids. While she supports the existing programs available, Ross says it “all comes from the top down.”

“There isn’t a crisis office to walk into (in the islands) or people who are reaching out to users on a personal level,” she said.

Ross said there should be a halfway house and job training program for recovering addicts.

“But will the community receive this? Or will people say, ‘not in my vacation destination’?” she said.

Local heroin statistics

• The sheriff’s office typically processes two heroin criminal cases per year.

• Orcas Medical Center is currently seeing 40 opiate addiction patients; Orcas Family Health Center is seeing 12. They are a mix of local and off-island residents.

• From 2011–2013, 90 to 180 patients were admitted into a publicly funded treatment program in San Juan County.

• 600 people die each year in Washington from opioid overdose with an increasing proportion of those deaths involving heroin.