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Heroin nightmare: Starting with Oxys

Physician: Heroin epidemic is 'like a metastatic cultural cancer'

FALMOUTH, Maine – Starting in high school, David and his friends would do Oxys in the car. Grind up the pill, snort it, go back to the house, smoke pot, watch TV. Repeat.

Two years after David finished high school, his stepmother opened a drawer in the room he shared with Michael and found piles of little packets. The boys told her it was cocaine. She learned years later that it was heroin.

The switch to heroin happened because their regular Oxy supplier had run short.

HOW DAVID DIED

From the countryside of New England to the cities of the Midwest, the most deadly epidemic of heroin use in half a century is tearing at the fabric of American life.

Part 1: David McCarthy's story

Part 2: 'The angel of death'

Part 3: Starting with Oxys

Part 4: 'He decided not to be'

Part 5: Enabling and denial

Part 6: Michael's story

Part 7: No more secrets

"It wasn't even a 20-minute conversation," said a friend who was with David that day. "It was really just that we couldn't get what we usually got and we knew it was clinically basically the same drug."

The guys snorted heroin, usually a couple of times a week, for years. Shooting up was something they saw in scary movies. But over time, they built up a dependence. They needed a fix just to get by, and they needed ever more to get high. They found themselves acting out of desperation — not breaking into strangers' homes, but stealing from their parents.

Four years into his heroin habit, David, having seen his friends shoot up, tried to do it to himself. He couldn't. "Dave had a serious aversion to needles," said a friend whom David called to ask for help injecting the drug.

"One hundred percent of the people who come in here say they never thought they'd put a needle in their arm," said Steve Danzig, a drug counselor who has worked with families in Falmouth, including the McCarthys. "But for somebody who's been using, it's not that big a step. Often, it's curiosity: You see somebody shooting up and it's clear he's much higher than you are. And it's often a financial decision, because you can get much bigger bang for the buck shooting it."

After a decade of widespread over-prescription of opiates such as Oxycontin, Percocet and Vicodin, the federal government pressed pharmaceutical makers to reformulate pills to make them difficult to snort, and it required physicians to prescribe fewer of the habit-forming pills. After Oxycontins were reformulated in 2010, street availability of the pills tightened; prices shot up.

"There can be no argument: Heroin has become much cheaper in the past two years because the crackdown on Oxys made it much harder to get pills on the street," said Dan Perry, the assistant U.S. attorney in Maine who is in charge of drug cases.

"It's like a metastatic cultural cancer — we went from virtually no intravenous drug use three years ago to now rationing care in a raging, untreated epidemic," said Mark Publicker, a physician who ran the Mercy Recovery Center, Maine's largest outpatient drug detox program, until it shut down last month because neither private nor government insurance would pay enough to cover its costs.

HOW DAVID DIED: Read part 4 of the series

In Falmouth, the turn from pills to heroin was evident in the decline of robberies at pharmacies. Opiate pills used to be stored behind the counter, and addicts knew it; an after-hours break-in could keep them flush with pills for months. Then pharmacies changed their practices; prescriptions for opiates now must be called in 24 hours in advance, and only the amount prescribed is delivered to the store. In the past two years, Tolan said, pharmacy robberies have largely ceased, replaced by heroin's surge.

For David and his friends, scoring their next fix was as easy as texting a friend.

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