When Christa Holt last used heroin in March, she was on a three-month binge. Still, she had to spin her arm in circles to pump hard-to-find veins with blood so that she could inject the drug.
The 27-year-old Arroyo Grande resident was at her nadir.
She had begun using methamphetamine at age 11. By her early 20s, she had become addicted to prescription pills. She turned to heroin this year after her younger brother, Andrew, died of a heroin overdose in 2011.
I was just curious what was so hard-core that killed my brother. Whats so awesome about this that my brother could not stop, she explained.
Holt and her 24-year-old brother tragically exemplify the growing presence of heroin in San Luis Obispo County.
Law enforcement officials and treatment specialists say the drug is relatively cheap, readily available and an easy replacement for widely abused opiate-based prescription drugs that are harder to find and less potent.
Black tar heroin, much of it from Mexico, is now nearly as ubiquitous as meth in the county, police officials say. (In recent years, Mexico has been second only to Afghanistan in heroin poppy cultivation, according to the U.S. Drug Enforcement Administration, and the drug is being smuggled across the border.)
Its important that the public know that this is not an issue that only happens in Detroit or Los Angeles and can happen here, said Brian Beetham, a sergeant with the San Luis Obispo County Sheriffs Office who heads the countys 14-member narcotics unit.
It is almost impossible to determine the extent of illegal drugs in San Luis Obispo County, law enforcement officials say, but their experience suggests a recent surge of heroin.
For the first six months of this year, the Sheriffs Office reported 44 cases that involved the seizure of heroin. That compares to 36 in all of 2011 and 22 the year before.
Over a longer period, the number of people in the countys drug treatment program using heroin as their primary drug has more than quadrupled since 2006, growing from 2.1 percent to 8.9 percent in 2011-12.
Furthermore, Beethams team is increasingly coming across heroin when deputies investigate other drug activity. And they are receiving a lot more complaints about heroin use.
It does seem, from our perspective, to be gaining in proportion in the last six months, he said.
While they have not come across massive quantities of heroin, it has become almost as normal in busts as meth, which Beetham characterized as the workhorse of the drug world.
He believes heroin has become more prevalent because a reformulation of prescription painkiller drugs such as oxycodone, commonly referred to as Oxycontin or Oxy, has made them harder to smoke and because heroin is relatively cheaper ($10 to $20 for a tenth of a gram) than Oxy ($20 and up for a pill).
For whatever reason, it seems like people that were formerly big into prescription meds are now moving to heroin, Beetham said.
Trajectory into drugs
Holt began using Oxy with friends in her late teens and soon wanted it all the time. She found a ready seller too; an older woman in Pismo Beach with a prescription sold her Oxy for $20 a pill.
At the height of my using, I would do, like, five a day, Holt said.
Then she was busted with 50 pills and convicted of felony possession. That began her long and mostly failed attempts at getting clean.
Holt rationalized her use of pills over harder drugs such as heroin.
Its not dirty; its not called black tar heroin. And it comes in a nice pill, she said.
Becky Torres, who manages an outpatient narcotics drug treatment center in Atascadero, said the majority of her young patients with heroin dependency have a similar trajectory to Holts.
In 2010 when she took over at Aegis Medical Systems Inc., it had 130 patients, with a mixture of individuals dependent on opiate prescription painkillers and heroin. Now, Aegis has 210 patients, including 60 percent with heroin problems, Torres said.
About 60 of her current patients are 18 to 26 years old (Aegis does not treat minors), and most started using Vicodin, moved to stronger Oxycontin and then to heroin because it was cheaper and easier to get, she said. Two years ago, only 10 of her patients were in that age group.
Torres said her older patients become dependent on prescription opiates and continue using them because they have the money and can navigate their way from doctor to doctor to get their fix.
Numbers on the rise
From an emergency medicine standpoint, its difficult to pinpoint the scope of heroin in SLO County, according to local doctors.
Since 2007, there have been seven accidental heroin overdose deaths in the county one in 2007, two in 2008 and four last year.
Holts brother Andrew was one of those who died in 2011.
He got out (of prison) on Sunday and he died on a Tuesday, said Suzie Craig, their mother.
Meanwhile, since 2006, only 19 people have been treated at local hospitals for accidental heroin overdoses, according to the Office of Statewide Health Planning and Development. Additionally, since January at least six of 35 patients administered with an anti-narcotic medicine used to stop overdoses were using heroin, said Joe Piedalue, director of operations for San Luis Ambulance, which operates countywide except in Cambria.
Medical officials and doctors caution against using drug overdose numbers to determine the extent to which any drug is used or its impact, because each drug acts differently on the body. Some are more apt to cause an overdose.
Trying to remain clean
Holt said shes been clean since March. She was drug-free for a time in 2011 after moving to Texas and living with relatives. She was pregnant and had a job.
But when her brother overdosed in May 2011, all of that fell apart. She took whatever illegal drug she could get.
When frustrated relatives dropped her at her moms house in Arroyo Grande in January, Holt had burned almost all of her bridges.
In her wake was a toddler son she no longer has custody of, a boyfriend who she said died of sleep apnea, and a criminal record. She kept using drugs, however, only stopping when her mom persuaded her to admit herself to Arroyo Grande Community Hospital.
Holt said she does not want to end up like her brother and one day hopes to reunite with her son.
But right now, she is living day-to-day.
Im trying to stay six months clean.
About 23 percent of those who use heroin become dependent on it. For them, withdrawal includes muscle and bone pain, insomnia, diarrhea and vomiting, cold flashes and severe craving.
Heroin is particularly dangerous because it can depress respiratory function, which is often what causes an overdose.
Dr. Mario San Bartolome, a Pismo Beach-based specialist in addiction, said dependency doesnt necessarily translate to addiction.
Addiction occurs when the dependency impacts the rest of a persons life to such an extent that all that matters is getting drugs.
Another addiction: Prescription drugs
While methamphetamine and heroin are major worries for local law enforcement, the illegal use and abuse of synthesized prescription opiates such as Oxycontin, codeine and Vicodin are on the rise, too.
Prescription drug abuse is our big issue, said Dr. Thomas Ronay, the countys emergency medical services agency director.
While it is impossible to say exactly how many people abuse prescription drugs locally, more people have accidentally overdosed on these drugs in recent years than on other drugs such as methamphetamine.
From 2006 to 2010, for example, 211 prescription drug overdose victims were treated at local hospitals, compared to 76 meth overdose victims, according to state statistics.
And last year, 27 of 44 accidental drug overdose deaths in the county were caused by some form of prescription drug, in most cases opiates, according to the San Luis Obispo County Coroner Unit.
Ronay attributes some of the drug overdose problems to a change in state legislation that encouraged physicians to more liberally prescribe painkillers which may have inadvertently helped cause an increase in dependency.