Philly’s Next Heroin Epidemic

THE STREET PRICE OF OXYCODONE HAS BEEN RISING, and it isn’t likely to drop again. All else being equal, prices go up when supply goes down, and the nation’s supply of illegal oxycodone has plummeted.

Florida was the source of most of the country’s illegally trafficked pills; its network of sham doctors, pharmacies and pain centers earned it the nickname the Oxy Express. Illegal—or dubious—sales boomed because laws were lax. Felons could open pain clinics and dispense pills. The state’s pharmacies lacked a monitoring system to catch doctor-shoppers. A former addict I spoke with said he had to flee a sober house in Florida because pills were so readily available that almost everyone in treatment would sneak out and make buys of 80-milligram Oxycontin tablets for $10.

In 2011, a set of strict laws and regulations in Florida began to choke off supply. The change was immediate. The number of doses purchased by Florida doctors in the first six months of 2011 dropped 97 percent compared to the same period in 2010. The result: far fewer pills available to illegal markets.

In Philadelphia, prices have soared: A black-market 80-milligram Oxycontin has gone from $10 to $40; outside the city, addicts say, it can be as much as $80. There’s no way to say for sure if the drop in supply from Florida is why, but it’s a reasonable explanation. I spent a few weeks attending open Narcotics Anonymous meetings in Hazleton. There are usually 15 or so people there—the ones who look under 30 are the ones with prescription pill and heroin problems. One night after a meeting, a group was talking about the drug scene in the area and how much it’s changed. I asked how long, in theory,­ it would take someone in Hazleton to score an oxycodone.

“I have no idea,” a man who looked to be in his 20s said.

What about heroin?

“Five minutes,” he said. “Just go down the block.”

If a drug epidemic is beginning, treatment professionals will be among the first to see the signs. The major public health risks—deaths by overdose and increases in HIV and hepatitis C infections—happen later­, when large numbers of users have transitioned from snorting or smoking heroin to shooting and sharing needles.

Laura Murray is the regional medical director of NHS Human Services Addiction, and oversees facilities like Parkside Recovery, a clinic in West Philadelphia that offers methadone maintenance as part of its treatment programs. She told me she’s seeing an increase in heroin use, “but the standard pattern is that they don’t go right to heroin. It’s pills. It’s Percoset, it’s oxycodone. They become dependent. When they stop, they get withdrawal symptoms. They take them just to stop feeling sick. They switch to

heroin because it’s much cheaper.”

Mario Ortalano, a 22-year-old recovering addict, understands the logic. He transitioned to heroin from Oxycontin in 2008, just as the price was moving up to $40 per 80-milligram pill.

“They were the same exact thing,” Mario says. “You would do an Oxy 80, you would be high as hell. You’d sniff a bag of dope and you’d be just as high. So think about it: You’re spending $40 for an Oxy 80 rather than $20 for a bag of dope.”

Lisa is 54 and lives in Bethlehem. She was a sales representative for a large company until she was laid off in early 2011. Her daughter, Alice, is 21. Alice began taking Vicodin at 19 after it was prescribed to her for tooth pain. Lisa isn’t totally clear on what happened next—maybe Alice had a bad boyfriend influencing her, maybe bad co-workers­—but when the Vicodin wasn’t helping the pain anymore, she somehow got her hands on oxycodone, and her usage quickly increased. Alice couldn’t get pills; Lisa had to cope with her withdrawal.

“I was ignorant,” Lisa said. “I didn’t know how sick a human being could get.”

Lisa’s credit cards started showing thousands of dollars in charges she didn’t recognize. A store where Alice worked claimed she’d stolen a thousand bucks. Lisa found needles in her daughter’s car a year ago.

“It’s not the life I thought I’d be living,” Lisa said, just before enrolling Alice in a detox program. “I’m sure there are parents who’ve gone through this. … I’m in the dark.”