Emergency rooms across California are continuing to see a rise in heroin overdoses, according to the latest state figures, while in El Dorado County there has been a decrease in opioid-related deaths. Law enforcement officials, however, argue that heroin use is still a major issue in South Lake Tahoe.

The new data, released by the California Office of Statewide Health Planning and Development at the end of January, showed that emergency room visits due to heroin are on the rise for all age groups, but the sharpest increase continues to be for those aged 20 to 29.

For the first three months of 2016, 412 people in that age group went to an emergency room because of heroin — nearly double the number from the same time period in 2012. Roughly 1,500 emergency room visits were from this age group in 2015 compared to fewer than 1,000 just three years back.

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At Barton Memorial Hospital in South Lake Tahoe, Dr. Lance Orr, medical director of the Emergency Department, said they tend to see more people suffering from symptoms of withdrawal than overdosing.

“The number of intentional or accidental opiate overdoses our physicians and staff see in the Emergency Department is not very high. As for side effects, we do see opiate withdrawal fairly frequently,” said Orr. “Typically, a patient will say they ran out of a prescribed opiate to explain the withdrawal. Though some may be withdrawing from heroin, it is more socially acceptable to say it is a prescription opiate, such as hydrocodone or oxycodone.”

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From 2009 to 2013 (the most recent numbers from the County Behavioral Health Directors Association of California), there were 30 opioid-related deaths in El Dorado County, which has a population of 181,737. Nineteen of those took place in South Lake Tahoe during an 18-month period in 2011-12. This puts El Dorado County on the lower end of drug-related deaths, compared to fellow Sierra Nevada-based Plumas County — the highest — which saw 25 deaths during that period with a population of just 18,859.

In fact, in 2016 there were no opioid-related deaths in El Dorado County.

“I wouldn’t discount that there is a rise in heroin use, but we’re not seeing deaths related to it,” said El Dorado County Sheriff’s Department Lt. Jim Beyers.

One possible explanation for this could be an increase in drug stores selling the opioid overdose antidote naloxone without a prescription and an increased awareness in the county of its availability. It can be purchased at both CVS locations in South Lake Tahoe.

FROM PILLS TO NEEDLES

The story of heroin use in South Lake Tahoe is not a new one — but it’s one that has persisted and is true in other communities across the country. (Nationally, there were 12,990 overdose deaths related to heroin and 20,101 from prescription pain pills in America in 2015, according to the American Society of Addiction Medicine.)

“Heroin addiction rarely starts with heroin. Most heroin users start with a prescription opiate, whether it’s a personal or friend’s prescription,” said Orr. “Starting in the 1990s, many doctors prescribed opiates for pain control. The focus was on treating the pain and there was less awareness about opiate dependency to alleviate pain. Opiates were prescribed for mild, moderate and severe injuries.”

Barton is in the process of hiring a physician board-certified in pain management to help patients explore non-addictive options for pain control.

Detective Justin Brock of South Lake Tahoe Police Department (SLTPD) said that after 10 years on the force, he had not met a single person who started directly with heroin until recently.

“I’ve met hundreds and hundreds and hundreds of people that were addicted to heroin, and up until recently I would have said I’ve never met a single one — although that’s changed now, I’ve met one person — that didn’t start using heroin after they started using prescription pills,” said Brock.

But with the high-cost of opioids on the street — $25-$50 per pill — users turn to heroin, which can range from $15-$25 for one-tenth of a gram, or a “point.”

From a law enforcement standpoint, SLTPD is seeing more heroin users than ever before. Between 2007 and 2013, the number of encounters bounced between zero to five. In 2014 there were 10, and in 2015 and 2016 there were 15 each year.

“Things come in waves in Tahoe, depending on availability. We see a whole lot of meth then heroin tapers off, then heroin comes back around,” explained Brock. “I would say around the mid-90s heroin started coming back and then early into the 2000s started growing, and just in the last five to six years it has blown up. Not just here, all over the country.”

The main type of heroin that SLTPD sees is black tar heroin originating from Mexico and coming into the basin through other hubs.

“We get a lot of heroin that comes in from the Reno area, but most of it comes from the Central Valley — Stockton, Modesto,” said Brock.

INVESTIGATIVE IMPACTS

Funding cuts and changes in legislation have impacted investigations into the sources of heroin in South Lake Tahoe.

Last November, the multi-agency South Lake El Dorado Narcotic Enforcement Team (SLEDNET) was dissolved after the California Department of Justice reassigned its personnel in 2014 and El Dorado County Sheriff’s Department did the same in 2016. With just SLTPD left, the task force was disbanded after 28 years.

Brock was one of the SLEDNET officers reassigned to a detective unit with a partial focus on crime related to drugs, while El Dorado County continued its undercover narcotics work through a county-led task force on the West Slope.

“In the event a large-scale drug investigation is necessary in the future, the SLTPD and El Dorado Sheriff are committed to pool resources to ensure we still have the capacity to do this important work,” SLTPD Police Chief Brian Uhler said at the time.

The passage of Prop. 47 in 2014 — which, among other amendments, turned possession of heroin from a felony into a misdemeanor — was another change that affected investigations into dealers, said Brock, and the consequence was two-fold.

“Before when it was a felony it was easy to find somebody who once they are incarcerated they go, ‘I don’t really want to live this lifestyle. I want to get out,’” explained Brock. “So they’d be willing to do things to work off their case, basically help us out, give us information.”

This resulted in more leads and people willing to go undercover.

Additionally, before Prop. 47, people caught using heroin would have the option to attend rehab instead of going to prison. Now they get the equivalent of a ticket.

“Your first time getting caught for possession you’d go in, you’d get diverted into drug court, they’d offer you the ability to go to rehab, and if you went to rehab and successfully completed rehab, then that charge would be dropped and that would be it,” explained Brock.

“And a lot of times people were getting two, three, four arrests and they were still getting funneled into drug court and it was one of those things were they could either get clean or go to prison, and they didn’t want to go to prison — who would — and so they were taking those steps. It wasn’t always successful, but they were at least seeing that as the rock bottom.”

Now, he said, the worst they are looking at is a year in county jail after multiple offenses.

“That’s going to be the person that’s been arrested seven to eight times for heroin, or has done something else to end up with that sentence,” said Brock.

LIMITED OPTIONS

A report from the National Institutes of Health states that, to date, only 20 percent of the nation’s heroin addicts have sought or received treatment for their addiction — and in South Lake Tahoe, there aren’t many options if you do.

South Lake Tahoe’s only inpatient rehabilitation center, Elevate Addiction Services, opened in 2008 and can accommodate 50 patients.

“We are a holistic program in the sense that throughout the program the client is not on medication. So we are not a program that utilizes maintenance like Suboxone, Subutex, and methadone,” said Jeremy Miller, public outreach for Elevate Addiction Services. “We offer a medically-assisted detox, but that’s as much as the client will use throughout their whole program.”

Miller said the main addictions he sees at the clinic are for opioids and methamphetamine, followed closely by alcohol. Clients are a mix of residents and people from out of town, with an average age of 18 to 25.

“The withdrawals are pretty intense for opioids. It’s pretty painful. Their legs especially are very restless, their muscles hurt, and generally they have a lack of appetite, and an inability to hold food and liquid down. And of course they don’t sleep for a while,” said Miller.

Tahoe Turning Point is the only other local institute offering treatment, which includes outpatient addiction counseling and transitional housing.

“A shortage of community support options is not helping,” said Miller. “We could always use more.”

But for Brock, it’s more about the dangers of returning to old habits in a small town.

“When I was working SLEDNET and I was working patrol, the people that I would come across that I would talk to about rehab, the very first thing I would tell them is get out of Tahoe,” said Brock.

“It’s not necessarily the number of rehab centers we have or anything like that, it’s that it’s a small town and a close-knit community. It’s very, very hard to stop using a drug, especially like heroin, when your buddy that you used to use with is right down the street.”