Megan McKee

A few years ago, I wrote a news blog about my hometown, Rockland, Mass. Welcome to Rockland (aka, me) took a nice long vacation starting in 2012, basking in the beauty of having a second child, then getting cancer and getting rid of it.

In the intervening years between the last Welcome to Rockland blog post, the town has come to grips with the opiate epidemic, with deaths reported seemingly every week

As I used to do back in the heyday of the blog, I took a couple of days recently to stroll the downtown area and check things out. Sadly, not much has changed except a few more “For Lease” signs and way more peeling paint. As the town has declined, so has the health of its population, it would seem.

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With a large Catholic population, Holy Family Church has been the center of many peoples’ lives. The priest, Father Hickey, is beloved by his parishioners, and has seen many families through births to deaths. The church also marks the northern entryway to downtown Rockland.

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The next photo is an iconic shot of downtown Rockland, as it features two of downtown’s historic buildings and the second steeple (in addition to Holy Family) that defines the outline of downtown. There’s also the empty space of a failed restaurant that replaced a once-popular Italian eatery.

And in preparation for my larger project, I played with the photo to come up with the cover photo for the hosted WordPress blog I created, wearerockland.com. The image is darkened to the point that overlaid white text will stand out:

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When I was in elementary school, I went to afterschool daycare at one of the older buildings in town, the McKinely School. The former school now serves as the town’s teen center, community center, a daycare, and hosts the town’s youth programs. The building has seen better days.

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When I was a kid, Rockland has a bustling retail scene. There was a shoe store, jewelry store, a greeting card and gift shop, a music store where I took piano lessons, and much more. These days, whenever a store opens, the chances of survival are, oh, 5 percent. We have dollar stores, a tobacco store (aka, pot paraphernalia store), and random business like MetalDetectors.com. Here are some shots of the retail scene, both occupied and not:

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Our Town Hall, also downtown, is sad:

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But the one shining gem downtown is our public library:

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One of the ongoing gripes people have on Rockland Facebook groups is discarded syringes in public places, so I went on a journey down the Rockland Rail Trail, which I had heard was ground zero for junkie discards. I didn’t find any syringes. However, I did find the following while on a nature walk in Hanover, a wealthier town next to Rockland.

When used correctly, Suboxone is used by addicts to curb cravings and avoid withdrawals, allowing addicts to taper off of opiates slowly. Addicts also use Suboxone to bridge the gap between when they have money and drugs so they don’t get sick. And if someone isn’t used to Suboxone or opiates, he or she can get high off of Suboxone. I tend to think based on the location of this wrapper that the Suboxone’s purposes were less than savory.

And since I couldn’t find any syringes, I tapped my ex, who is an insulin-dependent diabetic. Diabetic needles are the top choice for IV drug users. I made the “heroin” mixture with chocolate milk syrup and water.

In color:

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Professor Louisa Degenhardt – UNSW Australia

Although based in Australia, Degenhardt has a prolific and wide-ranging background of scholarship and research into many pertinent areas of my project including the use of methadone vs. Suboxone in treatment of opiate addiction, and a broad background in the mechanics of addiction.

Lianping (Mint) Ti – BC Centre for Excellence in HIV/AIDS

Ti is a research scientist with the  in Vancouver. She has researched how access to healthcare and harm reduction services impact people who use drugs, and was given a Canadian Institute of Health Research Rising Star Award, and her research is currently supported by a CIHR Fellowship.

Richard S Schottenfeld, MD – Yale University (Psychiatry)

His research is aimed at improving opiate maintenance treatment, specifically alternatives to methadone including other drugs like Suboxone combined with behavioral therapies. He is also concerned with the issue of access to opiate treatment in office and primary care setting to expand the availability of help to addicts.

Ingrid Binswanger, MD, MPH, MS – UC Denver

Studies prevention of opiate overdose, naloxone to prevent death in overdoses, and criminal justice involvement and its relationship to health.

Marc Fisher – Senior editor at Washington Post

Has written a bunch of articles about treatment and how it is to access and quit opiates.

Prof. Stacey Sigmon – UVM

In addition to studying the behavioral and phamacological treatment of opiate dependence, Sigmon studies the intersection of mental health and substance use, which is a huge aspect of addiction. Behavioral and pharmacological treatment of opioid dependence; Novel formulations of

Caleb J. Banta-Green, PhD – University of Washington, Alcohol and Drug Abuse Institute

Has done a ton of work on overdose prevention as well as well as many other relevant topics including how public health law affects overdoses.

Professor Richard P. Mattick – Drug and Alcohol Studies in the National Drug & Alcohol Research Centre at the University of New South Wales, Sydney

Has authored more than 100 articles and books on emotional, cognitive, and psychological problems. He currently focuses on treatment of young drug dependent people, and the efficacy of different pharmacological treatment methods for opiate dependence.

Daniel Alford, MD – BU public health big shot

(Copied directly from his online bio due to lengthy affiliations)

Alford is the Director of the Safe and Competent Opioid Prescribing Education (SCOPE of Pain) program at Boston University School of Medicine (BUSM). He is on staff in the Section of General Internal Medicine and is director of the Clinical Addiction Research and Education (CARE) Unit and Medical Director of the Office-Based Opioid Treatment (OBOT) program and Massachusetts Screening, Brief Intervention, Referral to Treatment Training and Technical Assistance (MASBIRT TTA) program at Boston Medical Center (BMC). He is a diplomate in Addiction Medicine by the American Board of Addiction Medicine. He is president of the Association for Medical Education and Research in Substance Abuse (AMERSA) an interdisciplinary organization of leaders in substance use education, research, and policy. He is the chair of the American Society of Addiction Medicine (ASAM) Buprenorphine Course for Office-Based Treatment of Opioid Use Disorders Planning Committee. He is course director of the Chief Resident Immersion Training Program in Addiction Medicine funded by the National Institute on Drug Abuse (NIDA).

In 2015 he was appointed to the Massachusetts Governor’s Opioid Drug Formulary Commission. He was recognized as a Champion of Change by the White House and in 2014 received the national AMA “Award for Health Education.”

Joseph Moses – DEA special agent and agency spokesman

Moses is cited in numerous articles on opiates, and has a 20+ history as a special agent. Building a relationship with him will be crucial for accessing DEA info and other officials.

At this point, most of us know the basic plotline: Heroin is an epidemic, fueled by the proliferation and abuse of OxyContin and other opioid pain relievers starting in the early 2000s. Unsuspecting and suspecting people who could no longer afford the pricey black market-rate of the pills were forced to either get clean or switch to the cheaper, much-deadlier opiate that had been stigmatized for so long. And unfortunately, it’s much easier to make the switch than it is to quit.

I wanted to look at some social media sites and statistics to track awareness and attention to the epidemic. Before I did this, I checked out what the Drug Enforcement Agency had for information on heroin. I found data that showed the seizures of multiple categories of drugs (scroll to the bottom of the page if you want to see the entire table; the hyperlink wasn’t working for me), then parsed out the last ten years of heroin seizures via a spreadsheet and made it into this chart:

As you can see, minus a spike in 2006, the upward trajectory starts slowly in 2008 and dramatically increases from 2010 to 2011, with the trend sustaining.

The DEA also published the latest National Heroin Threat Assessment Summary in April 2015, which is chock full of interesting, highly-alarming tidbits:

In 2013, 8,620 Americans died from heroin-related overdoses, nearly triple the number in 2010. [emphasis added]

The following chart accompanied the statistic:

The DEA also addresses the geographic threat of heroin, which it says in the East is currently being supplied by Mexican traffickers “expanding their operations to gain a larger share of eastern U.S. heroin markets.” Historically, Mexican heroin was found West of the Missisippi in black tar form and Southeast Asian white powdered heroin made up the bulk of supply East of the Mississippi:

The largest, most lucrative heroin markets in the United States are the white powder markets in major eastern cities: Baltimore, Boston and its surrounding cities, Chicago, New York City and the surrounding metropolitan areas, Philadelphia, and Washington, D.C., and these are the markets where Mexican traffickers are trying to gain a larger share.

Later on in the document, the DEA states that “Mexican traffickers control established transportation and distribution infrastructures that allow them to reliably supply markets throughout the United States.”

The DEA included this data visualization of survey respondents who said that heroin was the greatest drug threat in their area. We can see that New England, Middle Atlantic and Midwest states had the largest share of respondents saying heroin was the greatest threat:

So how does all of this pan out in social media networks and Google searches? By using Google Trends, we can see how people searched for different phrases over time, and where those people lived at the time.

Note that the points, which top out at 100 on the line graph visualizations, represent when terms were most searched and does not represent the actual number of searches. In other words, true to their source’s name, these points give us a sense of trends rather than actual volume.

People have been searching on “heroin” in a steady upward trajectory roughly since 2009, according to this Google Trends line chart, with the highest peak in Feb. 2014.  This correlates almost exactly to the DEA line graph of heroin seizures:

Volumen of Google searches for “heroin.” (Source: Google Trends)

Geographically, Google also lets us see from where people are searching. Below, we can see that just as the DEA showed in its latest heroin threat assessment, the Northeast, Middle Atlantic and Midwest regions are the hotbed of “heroin” Google searches.

Origins of searches for “heroin.” (Source: Google Trends)

There are other relevant terms that can be searched. How about “heroin withdrawal”? This trajectory is noticeably steeper than just heroin, perhaps reflecting a more intimate association with the drug and what it’s like to withdraw from it. Note that the peak was also in Feb. 2014, which is when acclaimed actor Philip Seymour Hoffman died from a heroin overdose after lengthy sobriety.

Volume of Google searches for “heroin withdrawal” (Source: Google Trends)

Here is the chart for “Suboxone,” a heroin replacement and weaning drug that has played a large role in the treatment of heroin addiction and is also sold on the black market to users who don’t want to be sick when they can’t obtain their opiate of choice. Suboxone was approved by the FDA in 2002.

Volume of Google searches for “Suboxone.” (Source: Google Trends)

Narcan (below represented in blue), known generically as naloxone (represented in red) have been crucial to saving the lives of people who overdose on heroin. Once given only via injection, there is now a nasal spray version. Many first responders carry it as standard protocol and it’s widely available for free to users and their loved ones.

Volume of Google searches for “Narcan” (blue) and “naloxone” (red). (Source: Google Trends)

And a look at the geographic distribution shows the same Northeast, Midwest and Middle Atlantic trifecta of interest in the term “Narcan.” Note how Massachusetts tops the list.

Origins of searches for “Narcan.” Source: Google Trends

Meanwhile, over in the universe of Twitter, I used Topsy to see how topics related to heroin have trended.

In the past 30 days, there have been 109,458 Tweets that mention the word “heroin.” In the past 22 hours, there were 3,062 Tweets, with many of them about the 74 heroin overdoses that occurred in Chicago in 72 hours this past week. According to the Chicago Tribune, authorities suspect that a batch of heroin was laced with fentanyl, an opiate significantly more potent than heroin that’s been responsible for a significant amount of overdose deaths. According to the DEA’s threat assessment report, “In late 2013 and throughout 2014, several states reported spikes in overdose deaths due to fentanyl and its analog acetyl-fentanyl.” The agency also expounded on its use and source:

…fentanyl is most commonly mixed with white powder heroin or is sold disguised as white powder heroin. While pharmaceutical fentanyl (from transdermal patches or lozenges) is diverted for abuse in the United States at small levels, this latest rash of overdose deaths is largely due to clandestinely-produced fentanyl, not diverted pharmaceutical fentanyl.

The Chicago Tribune article detailed the magnitude of the overdoses by including a quote from the hospital emergency room director who dealt with many of the victims:

They’re taking double and triple the doses of Narcan in order to bring them out of their stupor,” Hincks told the Tribune.

An interesting find via Twitter was the hashtag #UnitetoFaceAddiction in advance of an Oct. 4 gathering on the Washington Monument in Washington, D.C. Organizers said on the website that the event will bring together tens of thousands of people.

According to the social analytics tab in Topsy, the hashtag has been used 3,685 times in the past 30 days, with widespread use catching fire on Sept. 28 thanks to Dr. Oz urging retweets to promote the event.

On Twitter, I used the advanced search function to search for Tweets near my hometown, Rockland. This yielded leads for sources and recent drug busts, and pointed toward engaged local police departments:

Facebook also yielded some good sources for reporting. Just by searching on the term “heroin,” I came up with a plethora of community-based anti-heroin pages in Massachusetts. One group in particular is for parents and relatives of loved ones on the South Shore. I’ll be reaching out to them for personal stories. Here’s a screenshot of several of the pages:

In conclusion, social networks and analytic tools can identify trends, events and reporting sources while helping to find real life examples of issues that are conveyed by government agencies via faceless statistics.

One of the most fascinating aspects of drug addiction in the US is the synergy of geopolitical and domestic forces, and how they feed off of each other in often unseen ways.

For example, as explored in many major media outlets including the New York Times, the Washington Post, and the Los Angeles Times, and confirmed by the latest DEA heroin threat assessment, Mexico has become a major player in funneling heroin supplies to non-urban areas that have historically been exempt from easy heroin access, unseating Southeast Asia as the main supplier of heroin — higher-quality, at that, according to the Times — to the US.

And as US policy and law have cracked down on prescription opiates, heroin has become the de facto drug of choice for addicts who, whether consciously or not, find themselves dependent on opiates to stave off sickness.

In response, demand for heroin has surged and, as the Times notes, savvy cartels in Mexico with fingers on the pulse of American addicts have adapted their business models.

The home of a farmer in Calvario who leases his land for opium cultivation. (Rodrigo Cruz for The New York Times)

In an Aug. 29, 2015, Times article, we see fleshed out how this dynamic works in El Calvario, Mexico, a rural community nestled in the mountains of Sierra Madre de Sun in the most violent Mexican state, Guerrero.

“The cartels have a pretty good handle on the appetite in the U.S.,” said Jack Riley, the deputy administrator of the Drug Enforcement Administration. “They understand the prescription drug issue here, and that is one of the major reasons why you are seeing the expansion of poppy production.”

The article focuses on how a lack of opportunities and harsh poppy cultivating habitats contribute to luring children (or, more specifically, teens if the article’s sources are indicative of the larger under-18 poppy-farming population) into farming.

The steep grade and loamy earth make standing upright difficult, and on occasion adults tumble down the hillside and are injured, villagers say. That is where the children come in: Their slightness is an advantage come harvest time.

The children do not seem to mind. Several said opium was like any other crop they might be told to farm for their parents. Only it pays better.

The article points to loosening marijuana laws in the US driving down demand for farmers’ output of the crop, thus forcing them to consider other alternatives to make ends meet in a place with too few economic opportunities. This dynamic was also explored in an April 2014 Washington Post article:

The surge of cheap heroin spreading in $4 hits across rural America can be traced back to the remote valleys of the northern Sierra Madre.

With the wholesale price of marijuana falling — driven in part by decriminalization in sections of the United States — Mexican drug farmers are turning away from cannabis and filling their fields with opium poppies.

The Times article also hints at narco violence and its influence on government. In the Calvario area, the Sinaloa cartel rules, according to the Times. As one farmer said, “There is no real order here. We are governed by narcos.”

What’s clear from the article is that the link between poppy production and Americans’ heroin habits is lost on many of the small-time farmers who have other, legal crops that carry them through the rest of the year. Or, if they do know, they feel no moral weight. Simply said, a sheer lack of monetary sources drives farmers to grow the poppies cultivated for cartel distribution.

“It is not the drug production that generates underdevelopment,” said Antonio Mazzitelli, the head of the United Nations Office on Drugs and Crime in Mexico. “It is the lack of development that generates the opium cultivation.”