New Hampshire has seen a sharp spike in the number of people using - and dying from - heroin. And authorities say it's linked to the epidemic of prescription drug abuse.
In the mid-2000s, seven or eight people a year were dying from heroin in New Hampshire. In 2011, there were 49 deaths classified as heroin-related by the state Medical Examiner's Office, and last year, that number was 38.
Nine of those who died from heroin last year were 19 to 24 years old, 10 were 25 to 29, 15 were in their 30s and four were in their 40s, according to the Medical Examiner's Office.
The majority - 21 - lived in Hillsborough County, and six lived in Rockingham County; the rest lived in Cheshire, Grafton, Merrimack, Strafford or Sullivan counties.
Sgt. Brian LeVeille, who is in charge of the special investigations unit at the Manchester Police Department, said the city has seen "a tremendous increase" in heroin in the past five years. And he blames addiction to prescription opioids such as oxycodone for that increase.
"What they'll do is they'll switch right over to heroin when they can't get the pills because it's a very similar high," he said.
Heroin today is cheaper than prescription drugs sold illegally on the street, LaVeille said.
And it's not just the stereotypical street addict using the drug, he said. "Don't kid yourself: There are people out there, professional people, that are doing it."
Joseph Harding is director of the state health department's Bureau of Drug and Alcohol Services. He agreed heroin addiction often begins with abuse of prescription opioids.
Harding said part of the problem is a misconception that prescription drugs are harmless. "Because, well, after all, they're prescribed by a doctor, and you get them at a pharmacy, and they're made by a pharmaceutical company. How harmful could they be?"
But once the legal supply of a prescription medication runs out, Harding said, addicts still have a physical compulsion to use. And if they can't get the prescription drug, many turn to heroin.
From 2001 to 2011, admissions to publicly funded treatment programs for heroin addition doubled, Harding said.
Back in 2001, 454 admissions were for heroin, about 9 percent of all 5,250 admissions that year. In 2011, 1,091 people were treated for heroin addiction, about 18 percent of all 6,108 admissions.
In addition, there were 1,154 admissions for prescription drug abuse in 2011, compared with just 102 admissions a decade earlier, Harding said.
"So when you start combining these together, for the overall impact and consequence of opioids, it's just terrible," he said.
It doesn't take long for life to fall apart when you're a heroin addict, LaVeille said. "Before you know it, you're doing it seven days a week because you have to," he said. "It's a nasty, nasty drug.
"We deal with these people all the time. It's very sad to see, to be honest with you," he said. "And they're the most difficult people to deal with because they just have no control over any aspect of their lives. None whatsoever."
Police say folks in New Hampshire should care about the issue because the effects of addiction ripple through communities here.
"They're the ones that are out there doing the burglaries and the robberies because they're trying to get money to support their habit," LaVeille said.
"I have yet to come across a prostitute that's not a heroin addict. They're doing what they're doing to support their heroin addiction."
In his former work as an undercover officer, LaVeille has seen it all. And he said, "Heroin is by far, out of everything I've seen, the worst drug you can have an addiction to."
Anthony Pettigrew, spokesman for the Drug Enforcement Administration in New England, said heroin today is far purer than the street drug of the 1960s. So users don't have to inject it when they first switch over from prescription drugs; they can snort it.
"So it loses the stigma of seeing yourself as a street drug user," Pettigrew said. "But eventually any of the rehab places can tell you that people that started snorting it, they end up injecting it. That's the spiral."
There's a cruel irony to the heroin street scene, Pettigrew said. "If there are a bunch of overdoses, that actually attracts the drug users to that location, looking for that."
His agency's goal is to work back from the street user to the suppliers; he said the "clear majority" of heroin sold in New Hampshire comes from Colombia, by way of Mexico.
LaVeille said there's currently a heavy supply of heroin on the streets of Manchester; that's because of the city's proximity to Lawrence, Mass., which he called the "hub of the Northeast" for drug dealing.
For dealers, Lawrence has easier access to interstate highways than Boston, he said.
"If you've got a bunch of illegal drugs in your car, you don't want to get caught with it," he said. "You want to be able to get off the highway, drop them off, get back on the highway and go back to New York."
A 2012 report by the Governor's Commission on Alcohol and Drug Abuse Prevention, Intervention and Treatment found that the number of drug-related overdose deaths in New Hampshire has surpassed the number of traffic deaths in recent years.
"A Call to Action" proposed a broad range of strategies to address the prescription drug epidemic, including public awareness campaigns, improved prescribing protocols for physicians, more opportunities for disposal of unused medications and better prescription drug monitoring.
The Legislature last year passed a law to set up a registration system for certain controlled prescription drugs to try to prevent "doctor shopping" by addicts.