Ed Yaekle's road to heroin abuse started with long drives across the Upper Midwest to find doctors and pharmacists he could scam for pain pills. Yaekle was first prescribed drugs like Tylenol 3 and Vicodin after a 40-foot fall at a construction site in the early 1990s. Eventually, he started injecting ground prescription opiates into his veins to get a stronger kick.
"It got to the point where I was doing an incredible amount of those, and it was getting so cost prohibitive that I found it better to just turn around and sell the pills and buy heroin," Yaekle said. "Somewhere in the middle there, the line became blurred between pain relief and addiction."
Rates of prescription opiate abuse have steadily risen in Minnesota, like in many places across the country. But Minnesota is unique because it's also seeing a large jump in heroin abuse, partly due to users like Yaekle, whose prescription opiate addictions lead them to some of the cheapest and highest-quality heroin in the country.
EPIDEMIC OF PRESCRIPTION OPIATE ADDICTION
Prescription opiates are prescribed by doctors to manage pain from operations or accidents under names like oxycodone, oxymorphone or hydromorphone, all members of the opiate family that includes heroin.
As rates of prescription opiate abuse skyrocketed across the country in recent years, the Centers for Disease Control and Prevention classified the abuse of prescription opiates as a nationwide epidemic. In Minnesota, rates of prescription opiate addiction have risen dramatically since 2000, now accounting for almost 10 percent of treatment admissions, according to a recent Minnesota Department of Human Services (DHS) report.
DHS also found the number of people seeking treatment for prescription opiates or heroin increased fourfold between 2000 and 2011. In the most recent statistics from 2010, there were 92 opiate-related deaths, including both heroin and prescription drugs, in Hennepin and Ramsey Counties.
John Curtiss, president of The Retreat, a private treatment center in south Minneapolis, deals with the fallout from the increase in prescription opiate addictions.
"The more you see these medications prescribed, the more you're going to see them out on the streets," Curtis said. "It looks more benign, it's just a couple pills, and they don't realize that before you know it, you're taking six in the morning just to function."
When people get addicted to prescription opiates, they either go "doctor shopping," obtaining multiple prescriptions from different doctors, or buy prescription opiates for high prices on the black market. New state programs to oversee prescriptions across the country have also limited availability and increased the price of black market prescription pills.
LURED BY A FLOOD OF HEROIN
Heroin is relatively cheap and pure in Minnesota. A 2011 comparison of 21 cities using the most recent Drug Enforcement Administration data showed Minneapolis had the second most pure heroin, following only Detroit. Minneapolis heroin was also the cheapest in the country, at just 25 cents a milligram.
A 2011 study in the American Journal of Pharmacology and Toxicology found correlations that suggest that oxycodone could be a gateway drug for heroin, often because buying heroin is cheaper than prescription pills.
Prescription opiate addicts can also be lured to heroin because it's easier than scamming doctors or buying prescription opiates on the black market.
"Heroin is accessible just by texting, it's not like you have to hang out on a street corner, or go to a bad part of town or do any of that stuff anymore," said Carol Falkowski, drug abuse strategy officer for the Minnesota Department of Human Services. "Heroin's availability is so mainstream."
Michael Hooten, a pain management specialist at Mayo Clinic, said one question takes precedence for prescription opiate addicts, who are wracked by strong withdrawal symptoms: "What's the cost of the daily fix?
"I have definitely seen patients who in the course of receiving medical care for a pain problem, they will develop a prescription opiate addiction," Hooten said. "When they're not able to maintain their supply of prescription opioids, then they will turn to heroin."
PUBLIC HEALTH EXPERTS PUSH FOR EDUCATION
Public health advocates say more public education is necessary, as well as more training of general practitioners who hand out the bulk of prescription opiates but often receive little training in addiction.
"Pain is both a physical and an emotional experience, that's the actual definition of pain," Hooten said. "Chronic pain does not equal a prescription for an opioid."
Like most other states, Minnesota has established a voluntary program that allows pharmacists and doctors to track likely prescription pill abusers. But this only tamps down doctor-shopping, leaving intact supplies from unused prescriptions that are obtained through relatives or the black market.
Falkowski said one of the prongs of attack is to have more regular and convenient pill take-back programs, where patients can turn in unused drugs. Hennepin County is taking a step in that direction by installing three drop-off boxes for unwanted medicine next week.
While the public's attention was captured by successful campaigns against methamphetamine use in the early 2000s, prescription opiate and heroin abuse has been quietly increasing with little public awareness, Falkowski said.
"Heroin is much more hidden. Communities are much more reluctant to be tagged as having heroin, there's such a stigma involved," Falkowski said. "As a result, communities are much less likely to have community dialogue about heroin and other opiates, yet community dialogue is exactly what needs to happen to reverse these trends."
Law enforcement is also working on the issue following a massive raid of heroin and prescription opiate dealers in Duluth last year. The East Metro County Attorneys and Sheriffs are organizing a forum on prescription opiates later this month.
"I've never been an alarmist about anything because I've been in the drug field so long, but if there's anything people should be alarmed about, this is right up there," Falkowski said of opiates. "People who would never otherwise seek out illegal drugs can find themselves addicted to prescription narcotics, and from there it's just another sad story."
Yaekle, the now-clean father of four, runs an anti-addiction website. He remembers hearing about the "big monster" of heroin while growing up. His strong aversion for the drug was cast aside as his prescription opiate addiction grew.
"[Addicts] just don't realize how slowly they're bargaining away this and bargaining away that until the next thing they know they're somebody they don't recognize anymore," Yaekle said. "It's just so insidious because it weasels its way in the back door."