By Taylor Sisk
Despite what recent headlines across the nation might suggest, heroin didn’t just appear in suburban, small-town and rural America overnight.
A decade and more ago, counties in Appalachia were recording deaths from overdose of opioids – mostly prescription painkillers, but heroin as well – in excess of 20 per 100,000 residents. And a number of reports indicate rural law enforcement agencies across the country were confiscating heroin.
But relative to prescription opioids, heroin kept a low profile in small communities.
Times have changed.
According to the Centers for Disease Control and Prevention, heroin use has increased in recent years among men and women, most age groups and all income levels. Some of the most extreme increases have occurred in “demographic groups with historically low rates of heroin use: women, the privately insured, and people with higher incomes.”
And it’s exploding in non-urban communities: CDC data from 2012 indicated the rate of death from all types of opioids was 45 percent higher in rural areas than urban ones. The rural rate continues to climb at a more rapid pace.
Take, for example, largely rural Nash and Wilson counties, located about an hour east of Raleigh. From 1999 to 20003, Nash County had six overdose deaths and Wilson County had four. From 2010 to 2014, Nash had 27; Wilson, 22.
Though the official number of deaths since is not yet available, the rate has clearly accelerated. Unofficially, by the second week of January of this year more people had died of heroin overdose in Nash County than in all of 2015.
“To me, heroin is in New York City, it’s in Los Angeles, it’s in Chicago, it’s in Miami. It’s not in rural eastern North Carolina,” Mike Cannon, a realtor and resident of the city of Wilson, said recently.
But though he spoke in the present tense, Cannon was referring to the past, before heroin rocked his family.
Heroin in North Carolina today comes largely from Mexico, and is now plentifully available. Communities like the one where Cannon lives were less prepared than their urban neighbors, blindsided. Prevention and treatment options in these communities are generally fewer per capita than in urban areas and may be miles away. Activities to keep young people more productively occupied are often limited.
That last part is important, because young people are most vulnerable. According to the CDC, heroin use has more than doubled in the past decade among young adults aged 18 to 25 years, the steepest climb of any age group.
In suburban, small-town and rural communities, kids are dying.
Like most kids
Many factors give rise to addiction. For Daeqwon Currie, 26, one among them was boredom.
Currie became buddies with Jonathan Cannon back in middle school. There wasn’t much to do in Wilson, Currie said. The boys attended church and youth group, rang a few random doorbells and maybe egged a house or two.
They made their own fun. “When we got together,” Currie said, “something was going to happen.”
Currie and Cannon eventually started partying together, drinking, smoking weed – things most kids were doing, Currie said.
Most of their classmates then went off to college. Currie and Cannon stuck around.
“I think if we’d have gotten away,” Currie said on a recent afternoon, breaking from landscaping work he’s doing in his spare time, “things would have been a little different.”
By “different,” he means maybe not so many drugs, and maybe not the kind that lay you so low. Weed’s one thing, Currie says, with a tumultuous world of experience now behind him; pills are another.
“When you’re in the pill world, you’re in a whole different world,” Currie said. “You meet people who’ve been in that world for years – deep in it.
“When it comes to pills …” His voice trails away.
Then heroin, more readily accessible now, cheaper, and an immediate, spiraling high. In the haze of heroin, Currie found a more dramatically defined world.
“It’s the instant high, is why you’re drawn to it,” he said. The pills took a while to kick in. “But with heroin, it’s an instant release; it’s instant satisfaction. That’s what drew me into it.”
And the tendency, once there, he said, is to isolate.
“Even with the best of friends, you’ve got yours and I’ve got mine. You know what I mean? It’s different. It’s not like passing the peace pipe.
“That’s why it changes you so much.”
‘A safe place’
Currie has lost friends to heroin overdose. Four close ones come immediately to mind. He wears a bracelet in memory of Austin Wiggs.
In fact, it was at Austin’s funeral last spring that Currie last saw Jonathan Cannon. They’d gotten busted together in Nash County and were communicating strictly through Facebook. Both were being regularly drug tested, and were clean.
Currie had determined he was done with that world for good. At the funeral, he said, “I went up to him and I looked him in his eyes, and we hugged, and I said, ‘Man, I don’t want to come to another one of these.’ And he said, ‘Me neither.’”
The next one was Jonathan’s. He overdosed in the early-morning hours of Aug. 19.
“We kind of got thrown into this thing,” Mike Cannon says of himself, his wife, Becky and their resolve to ensure their community is aware of the pervasiveness of opioids. “As a parent, it rocks your world. You’re trying to put the pieces back together. How did we get here? How did this happen?”
When Jonathan died, he and Becky discussed with their other sons how to move forward.
“Usually when a child dies of overdose, people go underground, keep it hush-hush,” Cannon said. “We decided we would unzip and unveil.”
At Jonathan’s funeral, he reached out to his son’s friends. “The message was, ‘If you’re a friend of Jonathan’s, you’re either a user or you know someone who is.”
He offered “a safe place for these kids, someone they can call, help them get resources.” Since then, he said, he’s had about 70 kids in the area contact him. “For some reason, I’ve been tagged as an authority or an expert.
“But I don’t have a clue. I’m a guy that lost a kid.”
Possible
Currie is leaning on his faith to stay clean. He quotes Psalm 103:12: “As far as the east is from the west, so far has He removed our transgressions from us.”
But research indicates that most people require more – that medication-assisted treatment is the surest path to recovery.
Mike Cannon is learning a lot real fast. He now distributes naloxone that he receives from the North Carolina Harm Reduction Coalition. And he’s working toward establishing a nonprofit to run a rehab facility – one that would provide employment – for Nash, Wilson and Edgecombe counties. The nearest ones are in Greenville and Raleigh.
Heroin has frayed if not torn the fabric of already fragile communities. Nash and Wilson, like many largely rural counties throughout the country, have pervasive health care issues. Nash ranks 65th of North Carolina’s 100 counties in overall health outcomes; Wilson is 72nd. Life expectancy in Nash County is five years lower than in adjacent, urban Wake County.
Heroin worsens that predicament.
Like many local agencies across the country, law enforcement in Nash County now recognizes that arrest isn’t the answer. Nashville Police Chief Thomas Bashore launched the HOPE initiative, offering treatment to users.
And North Carolina’s Good Samaritan legislation provides limited immunity from prosecution for certain drug-related offenses for those who call for medical assistance because they fear they or someone they’re with may be overdosing.
Along with this, advocates say, stories must be told. Daeqwon Currie intends to tell his.
“People who are struggling, they want to know it’s possible,” he said. “They want to hear stories of hope. They want to know that it’s possible to overcome.”
Cannon likewise aims to offer hope: “Many [users] will go back to their old ways. But you’ve got to give them a chance.”
And he intends to further help break that silence: “There’s a stigma attached to it that we have to address; we’ve got to get rid of it. We need people to engage, get involved.”
“I’m 60 years old,” Cannon said, with a smile of inevitability, “and I guess this is what I’ll do until the day I die.”
[box style=”2″]This story was made possible by a grant from the Winston-Salem Foundation to examine issues in rural health in North Carolina. [/box]
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