The Heroin Epidemic

March 1, 2017

The Globe investigates a phenomenon that is on the rise in St. Louis and across the nation.


Drug cartels know how to make money and addictive drugs bring in profit. When there is a large availability of drugs, more people get addicted. When more people are addicted, more people are continuously seeking another high. And when they can get this high for low costs, that is when sales skyrocket.

It used to be marijuana that cartels focused on. But in 2004 and 2005, the United States started liberalizing its marijuana laws, and the drug cartels stopped producing marijuana. It was no longer profitable, especially as even stronger marijuana was beginning to be grown in the U.S. The drug lords still longed for money. So, instead of marijuana, they turned to heroin.

“The [drug cartels] don’t care about the people, they’re just trying to get all the money they can. They make [heroin] very available because they know it’s very addictive and they make it very cheap,” Dr. Evan Schwarz said, a toxicologist at Barnes-Jewish hospital and a professor at Washington University School of Medicine.

Heroin is an opiate that comes from the seeds of poppy (opium) plants. Just like opium and other opioids/opiates, it provides the user with a sudden sense of euphoria. Opioids and opiates both function as depressants and painkillers, and are often prescribed by doctors after surgery or other treatments to ease the patient’s pain. Commonly prescribed painkillers include Vicodin, morphine, and Percocet.

These drugs are highly addictive and overprescription can often contribute to a recovering patient heading down the path of becoming a heroin addict.

Opioids and opiates are divided by what comprises the two. Opioids are synthetic drugs made of chemical compounds while opiates come naturally from the poppy flower. As aforementioned, heroin is derived directly from the poppy seeds and falls under the opiate category, whereas the prescription painkillers which lead to the heroin addiction often opioids.

Heroin most often comes as a fine white or brown powder, but it can also be bought as a tarry substance (known as black tar heroin). Users can inject, smoke, or snort the drug to feel its effects.

Each time a heroin user shoots up, the outcome is unpredictable. There is no knowing what constitutes each different batch of heroin, or if it is what is called a “bad batch.”

“You just don’t know who you go to or what batch they have, because we have people who have done heroin for years but [they] get a bad batch and it kills [them] instantly,” Jessica Burnham said, an emergency room nurse at St. Alexius hospital in downtown St. Louis who deals with heroin overdoses every day.

The number of deaths related to heroin overdoses has been on the rise. In fact, according to the Center for Disease Control (CDC), this number has quadrupled since 2010 and in 2015, almost 13,000 people in the U.S. died due to a heroin overdose. On a regional basis, the midwest was second to highest in the country, with a total of 3,959 heroin overdose deaths in 2015.

Contrary to popular belief, heroin is not just an urban problem. After heroin became the drugs that cartels mass produced, usage rates in rural areas increased as well.

Brandon Costerison is the public awareness specialist for Curiosity and Heroin, a campaign run by the St. Louis based National Council on Alcoholism and Drug Abuse (NCADA) whose aim is to raise awareness on prescription opioid and heroin use. He believes that the cartels’ shift from marijuana to heroin is primarily responsible for this spreading of heroin from the city to the rural areas. Yet, he also believes that the increase is due to a lack of awareness in rural locations.

“It’s a combination of availability and perception of harm. Out there people don’t see much of a danger in it. They don’t recognize how dangerous some of these drugs can be,” Costerison said.

Without a doubt, the heroin epidemic is spreading.

There is a reason Costerison and his team at the NCADA have a campaign specifically targeting heroin use in the St. Louis area; the heroin epidemic has not skipped the river city in its destructive path across the country. In fact, many consider this epidemic to be one of St. Louis’s most pressing problems.

“Last year, our preliminary numbers said there were over 460 deaths in the St. Louis region. That beat the old record of 455. We’re seeing continuous increase in the number of fatalities,” Costerison said.

Not only is the rate of heroin related deaths rising in the St. Louis area, but treatment for heroin addiction surpasses many other drugs.

“When you compare heroin to cocaine, heroine is more than four times the treatment rate for cocaine. It’s about 50% higher than the rate for marijuana,” Costerison said. “It’s a lot higher than the rate for methamphetamine and a lot higher than the rate for prescription drugs.”

Although these facts indicate the rates of treatment rather than usage, they are indicative of heroin’s high prevalence in the region.  

CNN even did a special on the St. Louis heroin problem, stating that heroin deaths in the area were four times the national average. It seems that along with the Cardinals and the Arch, the heroin epidemic has also built itself into St. Louis’s name. 

The Scientific Lens

The Scientific Lens

“With heroin, the first time you use it you’re addicted,” Burnham said.

Although the addiction to heroin is a well known problem, few people truly understand just how little it takes to become hooked. Schwarz compared the irresistible draw to Heroin which a user experiences to a more commonly experienced addiction – candy.

Although at first glance such an analogy may seem like over-simplification, a deeper look proves that the two processes really aren’t that different. According to Schwarz, “If you eat a piece of candy and you like the feeling the candy gives you — that’s the same type of system that goes on in your brain and then your body is encouraged to eat more chocolate because you really like to have that experience again. Heroin and drugs hijack that system so it makes the body want to continue to use them and over time you actually get permanent changes in your brain and in your brain’s chemistry, which make it even harder to get off the drugs.”

Evidently, one use of heroin has devastating consequences, and as a result it is hard to understand what would motivate someone to do something so nocuous to themselves. According to Schwarz, “Whether they’re just experimenting or they’re covering up depression or something bad that’s going on in their life, it makes them feel better that first time. Over time, you’re generally not using it to feel better you’re using it because you can’t stop and now just trying to not feel bad.” Often, people turn to drugs during times of personal struggle or even to just try it, but end up falling victim to the addictive qualities of the drug.

Another primary cause of heroin addictions is something so familiar as doctor prescribed pain killers. Burnham explained that “We are seeing more because it all starts with prescription drugs. A lot of the kids end up getting wisdom teeth pulled out, and the doctors will put them on Vicodin or Percocet… and then they like that high they get, and people prone to addiction will seek out that high again, and prescription drugs are really hard to get off the street now, a it’s really difficult to get refills bc states have new laws and stuff, whereas heroin is really cheap to get, so they go to heroin bc they want that fix.”

Schwarz emphasized the biochemical influence of heroin on the brain. He explains that, “Catecholamines that are released such as dopamine and norepinephrine and when those things are released they cause the people to start wanting to do that again to get that release… The “reward” center of your brain with the dopamine and norepinephrine start tricking your brain to want to do these things. It starts changing the way your body works, your brain works, and its chemistry works so you just can’t think straight. It makes it very hard to stop because you lose that ability to make good decisions as well. So it makes it harder for you to make good decisions, in addition you have this stimulus that makes you want to to continue using even if you know that it’s bad for you.”

When a person has used heroin to the point where their body shuts down, the drug naloxone is often used in the form of Narcan by paramedics to reverse the effects of heroin. Heroin and “opioids are agonist drugs, which means they go on the receptor and cause it to work. In this case they cause you to stop breathing” However, respiratory arrest can be prevented by the naloxone, which prevents the receptors from working.

One of the most difficult parts of rehabilitation is the physical pain that comes with denying an addiction. Patients often experience difficult symptoms. “In addition to those physical nausea, vomiting, diarrhea; you also get these cravings of just really wanting to do it again which really makes things even worse,” Schwarz said.

Ultimately, heroin addiction is not something that is easy to bounce back from, and the journey to recover has plenty of physical and emotional difficulties. Still, it is important to recognize that hope in recovery always exists in therapy, medicine, and rehabilitation centers. And, although it may be the toughest step to take, a big part of recovery lies in the addict’s own hands.

“The best thing is realizing you have an issue — which is hard to do,” Schwarz said.

Heroin and Teenagers

Heroin and Teenagers


Most locals remember the advertisement that came across St. Louis television screens during last year’s Super Bowl. The public service announcement, aired by the NCADA, depicted a heroin user throwing away her hobbies, her schoolwork, her dog, and even her family because of the brutal effects of heroin addiction and the constant desire to get high again. Furthermore, the girl was shown to be a Lafayette High School cheerleader who started experimenting with pills at a party.

2016 was not the first year the NCADA had run an advertisement during this time when the majority of St. Louis televisions are being watched. In 2015, another clip portrayed a mother returning from the grocery store to find her son, a high school athlete, dead due to a heroin overdose. This announcement also highlighted the other common facet of heroin addiction; a myriad of users get their start from prescription pills. For the boy in the NCADA video, he had explored his mother’s medicine cabinet and eventually turned to heroin to fuel his dependence on the drugs.

Heroin is not solely an “adult problem.” Not only does it crawl its way into the lives of teenagers, but it often waits down the roads for adolescents who experiment with pills at parties or get hooked on prescribed medication.

Jack’s story began during his time at Wydown Middle School when he started smoking marijuana. Coming into CHS, Jack began experimenting with other drugs in order to gain approval from upperclassmen. “I wanted to be approved in their eyes, wanted to be one of the cooler kids so that’s why when I was a freshman was when I started using speed — more adderall or ritalin based drugs,” Jack said.

It all became a vortex from there.

Soon after, Jack started using Xanax, a benzo, and oxycontin, an opioid, which set him down the path of opioid dependence.

Jack went to a rehabilitation center his junior year of high school, and was sober for all of first semester senior year. However, his addiction got the best of him. “Second half of senior year is when I got back into it and that’s when I started using opioids pretty heavily” Jack said. “The urge to use inside of me became too big and I couldn’t control it anymore, so I started using again.”

As aforementioned, opioids offer a sense of euphoria and relief from physical and emotional pain, and it is for this reason that they appealed to Jack. The anxiety of college applications during senior year was a stressor that caused him to increasingly turn to the drugs.

“When I started using opioids, they always made me feel a lot more confident. They took the stress off, took the edge off,” Jack said.  

Jack slightly experimented with heroin his senior year, but it was not until after high school that his penchant for the opiate escalated. After years of prescription drug use, the expenses grew to be exhaustive, leading Jack to turn to this new source. Jack said, “[Heroin] was a lot cheaper than the pills and I could get the same high off of it for a fifteenth of the price.”

Jack was hooked on heroin. However, he had realized that this was no longer him just using drugs recreationally. He realized he had a disease.

 “When the drugs were taken away, all I would think about is drugs and using drugs. When I was using drugs, I’d be able to see how I was never satisfied with how much that high was,” Jack said. “It was just no way to live. I was doing crazy stuff to get the drugs and everything in my life was pretty much stripped from me. I knew potentially I was going to die pretty soon.”

Sarah had the same fears about her son. “When you hear that your child has been using substances that you can’t even pronounce, it’s a very scary feeling because you realize how close they are to death,” she said.

Out of all the drugs he experimented with, Jack is adamant that his run with heroin shook his life the most. “I was impacted most gravely by heroin because when I started using heroin, the people that I associated with changed and a bunch of other drugs that I had always said I’d never do just started getting introduced through heroin.”

Jack has recently completed a 12 month recovery program. Through sponsorship, Alcoholics Anonymous meetings, and a supportive community, he has been able to maintain a clean lifestyle. Nonetheless, the disease of addiction is still a battle he must fight everyday.

Jack is not the only Clayton student who got tangled up with heroin. In fact, Jessica Burnham’s younger brother, John, who attended Clayton during the late 1980s, dealt with a heroin addiction as well.

“They started out pot smoking [during] junior year. And back then, believe it or not, the high school had a smoking lounge right next to the commons. John would go out there because we always knew that’s where the pot smokers were that he’d hang out with, and it progressed from pot smoking that he started experimenting with heroin,” Jessica said.

Progressively using heroin using at parties, John’s addiction to the opiate worsened. Jessica and her family tried to place John in several rehabilitation facilities, but they proved to be unsuccessful in helping John get off his addiction.

After years of dealing with this addiction, John died at age 27 in 1998 from a heroin overdose. He was at a drug house on Maplewood, right off of Big Bend.

“I even have a picture, [my brother] is holding my daughter who was like two back then, from that Sunday, and Monday I was doing the ICU and my ex-husband called and said ‘your brother is dead at the ER at Saint Mary’s,’” Jessica said. “[My brother] had cashed his paycheck that Monday morning, and threw a little laundry in, ate a bowl of cereal with my mom, and was dead by noon.”

Jessica spoke at CHS after John’s death about the dangers of heroin usage and told her personal story. However, she felt that at that time, the late 1990s and early 2000s, the Clayton administration did not respond well.

“It was Clayton. You didn’t wanna talk about that it was county kids doing it,” Jessica said.

Jessica’s own kids attended Webster Groves High School. However, they are not exempt from the St. Louis heroin epidemic either.

John Raimondo, the assistant principal of Webster Groves High School, explained the situation in his community. “We really weren’t hearing much about heroin until about 6 or 7 years ago, and even that was just a small, very small group of kids, who were popular enough and connected enough with other students that it began to spread, almost like an epidemic” Raimondo said.  

He has been insistent upon improving the state of the school by involving the community in the fight against drug usage. Raimondo highlights the necessity of providing education in school against drugs, while also emphasizing the responsibility of teachers to report rumours that they overhear regarding students using drugs, so that the school can immediately contact the parent and prevent further damage. Raimondo points out that community contact is essential especially for kids who would be the least expected users.

“It’s across academic achievement, students that we know are using are getting A’s, they are getting B’s. C’s, F’s.  I think sometimes when parents see that their kids are doing well in school, they tend to think that [heroin usage] wouldn’t happen, but it does,” Raimondo said. “No parent wants to think, or deal, with the fact that their kid might be using, and a lot of kids are. It is so important for parents to be vigilant and not assume everything is ok, they gotta just keep having those conversations, if we can’t as staff just think they’re just kidding. We’ve got a responsibility to let a parent know that we are hearing things, and the parent has to make their judgement, and if they’re concerned then they take the next step.”

Jack’s experiences, although they took place in Clayton rather than Webster, reflect exactly what Raimondo was referring to.

“I was a pretty good student and I played sports, and people like me weren’t necessarily looked into by the administration,” Jack said.

Although Jack and John both got their start with heroin through experimentation with other people or in parties, another factor often leads teenagers down the same path — mental illness.

The teenage years can be tumultuous times, specifically regarding mental health.

“Sometimes teenagers are struggling and it can be a difficult time in life with all the changes and they can inadvertently look for (opioid abuse) as a way to escape and unfortunately what they don’t realize is that it’s actually gonna make everything worse,” Schwarz said.

However, making it through the teenage years without an addiction is a good sign.

Schwarz affirmed, “if you get through these teenage years and you’re not using this stuff, it’s less likely to get addiction down the road.”

The Political Lens

Students from Debra Wiens AP Government Class in Jefferson City lobbying for the 911 Good Samaritan Law

Students from Debra Wiens’ AP Government Class in Jefferson City lobbying for the 911 Good Samaritan Law

Laws can save lives. Missouri is lagging behind other states when it comes to creating these medically imperative laws and government programs.

Out of all fifty states in the U.S., Missouri is the only one that does not have a prescription drug monitoring program (PDMP).

Nevertheless, Costerison and his colleagues at the NCADA believe that prescription drug abuse is the primary cause for heroin addiction.

“80% of the people who use heroin started with those pills because it works the same way on the brain and heroin is cheaper and more available so people who can’t get those pills move over to the heroin,” Costerison said. “We think that by raising the awareness about the prescription pills to start off with, that that will decrease the number of people using heroin down the line.”

Having a PDMP would ease the process for both government officials and medical practitioners, as it allows prescription drug use and prescription to be monitored and abuse to be prevented.

According to Safe and Strong Missouri, an organization promoting a Missouri PDMP, State Representative Holly Rehder (R) said, “The only fix for opioid addiction in Missouri is a prescription drug monitoring program.”

However, the database has been stalled in its journey through Jefferson City. Senator Rob Schaaf (R) has vociferously voiced his opposition of the bill on grounds of a privacy breach and stopped the program in making its way out of Missouri legislature.

Another approach is the passing of the 911 Good Samaritan Law which Missouri currently lacks. These laws are designed to reduce the amounts of heroin deaths and get people to recovery faster.

Currently, many heroin users and dealers hesitate to call for help due to a fear that they will be arrested. Jessica sees this firsthand during her emergency room shifts.  

“What [users] do is a lot of times if you are at the drughouse and they stop responding to anything, the drug dealer will take the license plate off his car, take him to the ER, push him out of the door, and then run,” she said. It is for this reason that many St. Louisans advocate for the Good Samaritan Laws, as these would allow a user to take their friend to the hospital or call 911 without being immediately prosecuted, unless the caller is a dealer.

The laws have the approval of doctors such as Schwarz, and have scientific evidence to back them despite opposition which has emerged. Many people worry that the laws will enable heroin users to continue with their drug abuse. However, Schwarz disagrees.

“People with addiction problems are going to use. No matter what any of these things do — Good Samaritan laws, clean needles, over-the-counter naloxone — people are going to use whether you have these programs or not,” Schwarz said. “In the addict’s mind they’re not thinking ‘oh it’s safer.’ That’s not how their mind thinks. They know what they’re doing is dangerous they just can’t stop. So these things are actually very helpful because youre talking about saving people’s lives.”

Schwarz also uses clean needle exchanges as an example of such programs’ merit.

“If you look at data, for instance clean needle programs,” Schwarz said.  “If people are going to inject, they can get clean needles. There is no data that they take more drugs. If they’re going to inject,they’re going to inject. They’re either going to inject with a clean needle or a dirty needle so it might as well be a clean needle so that there’s less of a chance that they get an infection and that the medical system has to deal with that infection.”

Debra Wiens, an AP American Government teacher at CHS, is a vehement supporter of the Good Samaritan Laws and has been pushing Missouri legislature to pass the laws.

In her AP Government class, students can choose an issue to focus on and lobby for in Jefferson City. Last year, the students decided to follow Wiens’ path and pursue the passing of the 911 Good Samaritan Law. The students thoroughly researched all aspects of the bill and realized that this law was essential to saving lives and helping stop the drug epidemic in its way across Missouri.

“We contacted legislators in other states and asked them about their 911 bills and how they got it passed. We talked with lobbyists, legislators, college professors. We had Robert McCulloch, the county prosecutor, come in,” Wiens said. “So we really understood that this is a crisis, it needs to be dealt with.”

In her fight for the laws, Wiens has been in contact with State Representative Steve Lynch (R), sponsor of the 911 Good Samaritan bill. However, Lynch has been unsuccessful in convincing his fellow Republicans to pass the bill.

According to Wiens, this failure is due to the deliberate organization of the legislature meetings. Lynch’s bill was the last to be discussed during the sessions and due to late timings, many of the witnesses who were going to testify ended up having to leave.

Nevertheless, both Wiens and Lynch are hopeful for the upcoming legislative season which has just taken off this past month.

Wiens and her students made a trip to Jefferson City where they met Lynch. He was grateful for the student support and interest and wanted them to return for the 2017 legislative session.

“He was thrilled to have Clayton High School kids that expressed such interest,” Wiens said. “He said we should get in contact with him at the beginning of the legislative session, which would be now, and work with him to help get publicity and testify about the bill.”

Wiens encourages politically active students to get behind this bill and take action. She feels that this bill, if passed into law, would dramatically help save lives. As far as what students can do, Wiens suggests calling the state representatives and even lobbying. As young members of the American democracy, she pushes students to use their voices to make a difference.

The Stigma

The Stigma

“Clayton was really small back then, so you knew everybody…The [administration] knew he was in treatment. Back then, I guess it was taboo, you didn’t talk about it,” Jessica said, regarding Clayton at the time of her brother John’s death. Heroin had a stigma at Clayton High School in the 1980s, and that attitude remains today.

However, medical professionals and researchers of this epidemic have declared heroin as a mental illness, as addiction is a disease regarding the brain being taken over by chemicals. With the societal opprobrium that exists today, one poor decision can ruin a person’s life and one addiction defines a person.

“This is a disease, it’s not just someone choosing to make poor choices over and over again. This is a disease just as diabetes and high cholesterol and high blood pressure are all diseases as well,” Schwarz said.

While addressing the dangers of heroin, it is imperative to remember that the users are real people. Jack and John were both regular Clayton High School students who simply “got sucked into the wrong crowd,” according to Jessica.

It cannot be denied that someone who chose to use heroin made that decision for themselves. However, the medical classification of addiction as a mental health disorder proves that the ignominy which society shows users needs to be re-examined. One bad decision can lead to irresistible neurological chemicals, regardless of a person’s desire to quit.

“It’s because addiction physically and mentally takes over the body, and without getting proper help they just can’t stop” Schwarz said.

No matter how much a person wants to quit, the chemical damage to the brain has been done, and as a result they should be treated with care and not ostracized.

“I wouldn’t be able to stop once I started– no matter how badly I wanted to” Jack said.

After years of experience dealing with heroin addicts and the negativity that surrounds the drug, Costerison has also found it hard to push through the stigma that surrounds heroin addiction. He is still advocating to the public today to encourage looking at heroin addiction as a mental illness rather than characterizing it as an identity flaw.

“We talk a lot about how dangerous heroin is. We talk a lot about how it’s destroying our communities,” he said. “But there’s two things that I think are really important to recognize. The first thing is that we’re dealing with a mental health disorder. Substance abuse disorders are mental health disorders. We can’t have societal prejudice against people with these mental health disorders, it’s just going to push them into worse and worse places. It’s like having prejudice against one for having bipolar disorder or depression, it’s ridiculous.”

“The second thing is that there’s a lot of negativity that’s around us. But we have to remember that there is hope. People do recover. And with support and treatment, recovery is possible and we fully support getting treatment.”

Heroin does not define a person. It is something that happened to them and something that will impact their lives. Nevertheless, it is the public’s duty to support the victims of this drug, because contrary to popular belief, they are not the perpetrators.

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    Henry MohrmanSep 30, 2017 at 4:12 pm

    An excellent piece. I would note that prejudice against all people who suffer from mental illness is understandable, because people who have or have had mental illness exhibit or once exhibited behaviors that are very troublesome for their families, classmates, co-workers and people they meet on the street. In fact, social problems arising from mental illness (including addiction) are often the key to first diagnosis. I strongly support resistance to stigmatizing the mentally ill. The path to that end lies in understanding very troubling behavior as a symptom of possibly serious disease, while realistically recognizing that the symptoms are often hard to tolerate.

    I commend the authors for their excellent work and hope they continue to make a contribution as they have with this article.