Coos County's struggle with drugs is poised to get worse.
Experts fear that heroin will soon replace meth as the scourge of the South Coast, bringing with it a new level of disease, dependency and desperation.
Heroin-related arrests in the region jumped to 41 in the past year - five years ago, police arrested only two people for crimes linked to the drug.
Toby Floyd, director of the South Coast Interagency Narcotics Team, said those arrests were only "skimming the surface" of heroin's new presence on the streets.
The rise of heroin is the result of a combined rise in prescription-drug abuse on the South Coast.
The key ingredient in these substances, opioids, give users a euphoric buzz and are highly addictive. Many prescription drug users are turning to heroin as a cheaper and more intense opioid hit.
"We have always had heroin, but never as prevalent," Floyd said.
Floyd said a major reason for the recent cross-over was a change in the chemical formula of OxyContin in 2010. The prescription pain reliever once was heavily abused and sold on the black market, but its manufacturer made it less easy for abusers to smoke, snort or inject.
On the streets of Coos Bay, heroin now costs only $25 for a dose compared with about $80 for a high-strength pill of OxyContin.
The increase in demand for heroin is leading to an increase in supply in the South Coast, said Floyd.
"I think that it's going to reach a level that we have seen locally with the meth epidemic," Floyd said. "That's speculation on my part, but it's entrenched here now - heroin/prescription-drug abuse."
Floyd isn't alone. A growing number of drug experts say that the U.S. is floating on a rising tide of heroin. Oregon officials fear that the South Coast, for a variety of socio-economic reasons, will be the hardest hit in the state.
While the meth epidemic has been costly and painful for Coos County, they also fear the toll of heroin could become far greater.
‘Appalachians of the West'
ADAPT, Coos County's addiction treatment network, is treating a growing number of people for heroin and prescription drug addictions this year.
John Gardin, ADAPT's director of behavioral health and research, warns that just as cocaine ruled the '80s and meth the '90s, opioids will be America's drug for the decade.
"I don't know what will come next, but I think that's what we are seeing with prescription drug use," he said.
Gardin said the South Coast was the most vulnerable region in Oregon because of its higher-than-10-percent unemployment rate and entrenched poverty.
The region sometimes is called "the Appalachians of the West" by experts.
"The Appalachians in the East are known for intensive opiate abuse," Gardin said. "And it's because of the high poverty and lack of hope in the community."
As users increasingly turn from prescription opioids to heroin, he feared it meant bigger health implications than the region's well-publicized meth epidemic.
Chronic users may develop liver or kidney disease, abscesses, collapsed veins and infection of the heart lining and valves. The bigger fear is the spread of blood-borne diseases.
"Meth users, of course, have significant health issues as well, but the whole HIV/AIDS issues are more to do with heroin," Gardin said.
While meth mostly is smoked by users, heroin addicts almost always pro-gress to injecting the drug. That means heroin users can easily spread diseases between each other if they don't sterilize their needles.
"As heroin problems increase those problems increase too, and we will not be well prepared for them. We haven't been much concerned with them before."
And while meth is technically more addictive than heroin (50 percent are likely to get hooked compared with 35 percent who try heroin), heroin creates a dependence.
Rebecca Baer, 22, a former meth addict who is now in treatment, says meth withdrawal is nothing compared to heroin withdrawal. While she hadn't tried it herself, she had seen former addicts in her classes hunched over, sweating profusely, in physical pain.
"There's actually someone who is in and out of my meetings. He can't stay off of it. There's a woman in my recovery class -she will come in and be sober for 30 days but she can't put down the needle. In my opinion, if your kids can't make you put down the needle, nothing's going to."
By comparison, while meth withdrawal wasn't pleasant, it wasn't nearly as severe.
"You're just tired, you sleep a lot. For the first two months I was here, I slept a lot."
Bay Area Hospital has, so far, not recorded an increase in overdoses of heroin or patients with blood-borne diseases.
However, Jessica Quinlan, clinical manager of ED and ICU, said any prospective increase of heroin abuse is concerning.
She said it is a "whole different ball game" compared with meth. The volatility of heroin's strength means it could be easily overdosed.
"Depending on what it's cut with. If a batch comes along that's really good, and you're used to the medium batch, that's where we see the ODs."
She remembered when cargo ships would arrive in port, 10 or 15 years ago, occasionally carrying smuggled heroin into Coos Bay.
"We would have ODs all over the place."
However, she was optimistic that because Coos County has a low level of HIV and AIDS that the disease was unlikely to spread if heroin became more prevalent.
But, Quinlan added, "we can only hope and pray they use needles that are clean."
The I-5 drug corridor
The South Coast is well-placed to receive heroin because of its position next to one of five known "drug corridors" in the U.S. The I-5 is one of the main paths that drugs are trafficked on from Mexico to Canada.
HIDTA (High Intensity Drug Trafficking Area), a federally funded counter-drug agency, says that heroin, once only a city drug, is now arriving in rural areas like Coos County.
Chris Gibson, director of Oregon HIDTA, said the majority of heroin in Oregon was "Mexican tar," a black, less-refined heroin produced in Latin America. This is opposed to "China White," a purer powder form common on the East Coast that is refined and shipped from Asia.
Mexican tar, like the majority of heroin worldwide, is produced from poppies in Pakistan and Afghanistan. These poppies are shipped to Latin American, where they are refined and then pushed over the Mexico-U.S. border by cartels.
Drugs are trafficked in passenger vehicles and, increasingly, long-haul passenger buses toward Canada. Heroin then is dropped off to satellite areas, like Coos Bay, either physically or by mail.
"Craig," a spokesperson for Narcotics Anonymous who only would talk under the condition of anonymity, said users were aware of the change in the local drug scene.
He said he knew this based on a conversation with a former drug counselor.
"Heroin users used to drive to other places, for instance Eugene and Portland, to buy heroin," he said. "Now, heroin is being brought to Coos County for distribution and sale. ... It would make sense that if it's more readily available, people are more willing to use it."
The three-legged stool
Tackling heroin is an onerous challenge for state and local agencies who are suffering from steep budget cuts.
Gibson, who works with authorities across the entire West Coast to "disrupt and dismantle" drug rings, says he is only one part of that response.
He said heroin could only be curbed by targeting supply, education and treatment.
"It's like the three legged stool," Gibson said. "Without the support of all three legs it's going to wobble. We have got to do a better job on all three."
Those legs are particularly wobbly on the South Coast. On the enforcement side, the region's sole counter-drug agency, SCINT, now has only half of the seven to eight detectives it had in the early 2000s.
SCINT's budget increased dramatically last year after an injection of federal stimulus money, but those funds will dry up after 2012.
One of Floyd's detectives specializes in heroin, but with only a total of four detectives, the agency can't afford to allocate more to dismantling heroin trafficking and organization.
The region may have bigger challenges in terms of educating teenagers about drugs.
ADAPT cut back its prevention campaign five years ago after Oregon legislators began budget slashing at the beginning of the U.S. financial crisis.
"I think we had 15 staff involved in schools in Douglas and Coos County, and now I think we have one or two," Gardin said.
Without good information or early intervention, teenagers are more likely to experiment with drugs. Increasingly, prescription drugs are replacing marijuana as a teen's first drug experience.
"There are ‘pill parties' where kids will just take anything that's in a bowl," said Gardin. "That's kind of scary."
Heroin addicts in the South Coast also have limited options for treatment. Gardin said there was no state funding for detoxification and so local addicts had to travel to centers in Eugene and Portland.
His organization can only treat people after they become "clean" first. This means a heroin addict has to go cold turkey if they want their help.
And, while ADAPT is a nonprofit, its services aren't free. Ninety-day treatment can cost $1,850. While the center uses a "sliding scale" based on financial circumstance, it's still a steep barrier for addicts who might choose help before they are ordered to take it by the courts.
"Most people who have drug or alcohol problems will never walk through our door," Gardin said.
Ultimately, as funding for treatment decreased, Oregon only could target the most heavily dependent users. And, ironically, that is the least effective use of treatment spending, many say.
"The biggest bang for your buck is in the early stages of abuse and dependency, so we end up spending more money on worse problems and getting less results," Gardin said.
However local and state policymakers choose to tackle the South Coast's growing demand for heroin, its core drivers, like most serious drugs, run far deeper.
"There are certain factors related to excessive alcohol and drug use, and financial stress is one of them," said Gardin.
With the South Coast leading the state in unemployment, drugs provide a cheap way of coping.
But while the economy swings up and down, experts say, the presence of highly addictive drugs like heroin becomes entrenched.
Floyd said those users hurt not just themselves but leave a wake of damage to their partners and their children. They create a legacy of drug dependence.
Baer knows that better than anyone. She turned to meth partly after growing up in a household with the substance, alongside cocaine, alcohol and marijuana.
While she has wrested herself from the drug scene, she has seen the signs of heroin's growth. She knows a friend in jail on heroin charges.
She fears for the environment her 6-month-old child, Alaynah, may grow up in.
"I can only imagine what's going to be out there when Alaynah is 14 or 15," she said. "It makes me scared to put her in a public school because it's going to be everywhere."
Reporter Daniel Simmons-Ritchie can be reached at 541-269-1222, ext. 249, or at email@example.com.