No one sets out to die a heroin junkie.
The highly addictive narcotic is a drug of last resort for addicts who can never be sure of its potency or purity, but either graduated to it after abusing other street drugs or turned to it as a cheap alternative to prescription painkillers they no longer can afford, according to law enforcers.
Its use is on the rise statewide, as seen when heroin for the first time became the top killer of all drug overdoses in 2012. It was responsible for 38 of the 164 drug deaths that year.
The number of people who died from heroin in 2013 already shows a 50 percent increase and could go higher once all pending cases are closed. So far, heroin is responsible for 57 drug deaths in 2013, a year when authorities expect the total deaths will reach 200.
"It's a huge problem," said Dr. Thomas Andrew, the state's chief medical examiner.
Andrew said the number of total unintended drug deaths rose 400 percent from the 53 recorded when he started as medical examiner in 1997.
Speaking from a personal point of view as a physician, Andrew described the situation as a "public health crisis," but isn't sure the "social will" exists to really attack it.
"Are we going to decide as citizens that it is worth going after this problem in an aggressive way, or are we willing to write off these people as not worth the effort?" he asked.
"Are these really acceptable losses to us? ... In the end, every one of these cases is someone's son or daughter or sister or brother."
Heroin addiction also is blamed for the alarming rise in violent armed robberies, burglaries, scrap metal thefts, doctor shopping and pharmaceutical holdups, law enforcers say.
"It is very clear to me that the societal impact of drug abuse and addiction continue to increase and is spread across the state," said Col. Robert Quinn, director of the New Hampshire State Police.
The problem is not just one the state "can arrest and jail your way out of," Andrew said. More resources are needed for counseling, treatment and developing community-based programs to address it, he said.
Andrew was impressed that Vermont Gov. Peter Shumlin devoted his Jan. 8 State of the State message to what Shumlin called "a full-blown heroin crisis" that must be addressed with prevention and aggressive treatment.
A spokesman for Gov. Maggie Hassan said the governor considers heroin and other substance abuse to be "one of the most significant public health and safety challenges facing our state and our region.
"The current state budget includes increased funding for alcohol and drug abuse prevention programs and allows the state's Medicaid program to provide substance abuse treatment coverage, spokesman Marc Goldberg said.
In addition, accepting the more than $2.4 billion in federal funds to expand Medicaid would provide more than 50,000 working Granite Staters with access to substance abuse and mental health coverage, he said.
Opiates have always been the preferred drug in the Northeast, with oxycodone being the most popular, New Hampshire State Police Sgt. Marc Beaudoin said.
"In New England, we've always liked our opiates, whether that is heroin, oxycodone or hydrocodone," said Beaudoin, who worked in the state's police drug diversion unit from 2010 until last December. The unit is responsible for investigating prescription drug abuse.
Oxycodone is the most popular of the three, he said. A widely prescribed painkiller, it often leads to addiction among patients, and when their prescriptions run out, they buy it on the streets, he said.
"If you buy it on the street, you paid $30 for a 30 milligram pill, but you knew what you were getting," Beaudoin explained. But the supply of oxycodone has diminished in the last year, driving the price up to $35 to $40 a pill, he said.
That has forced many oxycodone addicts into heroin, where a single-dose bag containing a tenth of a gram can run as low as $5 to $10 in urban hubs such as Lawrence, Mass., and Manchester and $12 and up in rural areas, said New Hampshire State Police Lt. John A. Encarnacao, who has been commander of the Narcotics and Investigations Unit since September 2012.
"When I first came in to the unit, I was astonished at the amount of prescription drugs that we were buying as a unit. I can say now a lot of those prescription drug cases are heroin cases," Encarnacao said, referring to undercover drug buys made by investigators.
Heroin is not only cheaper, but also purer and easy to get, authorities said.
But its potency varies, it's highly addictive, and no buyer really knows what else could be in a dose, police said.
While executing search warrants at drug houses, Encarnacao said, investigators often talked with addicts who were present.
"None of them wanted to be heroin junkies. They all needed help," he said. Heroin addicts need treatment when they withdraw from the drug because they are physically addicted. But, he said, there isn't enough funding for these programs.
In 2012, heroin accounted for about 10 percent of the cases handled by the New Hampshire State Police Forensic Laboratory, Col. Quinn said. This was the first time in the laboratory's history that heroin cases outnumbered cocaine cases, he said.
In 2013, heroin accounted for 16 percent of the lab's cases, making it the third most common drug analyzed there, behind marijuana and pharmaceuticals, he said.
In addition, Quinn said, the laboratory discovered "fake oxycodone tablets" that actually contained heroin to increase dealers' profits.
"The cheaper price of heroin has forced many individuals who became addicted to opiate painkillers to resort to heroin abuse," he added.
Beaudoin said some hospitals, doctors and dentists have become increasingly aware of the problem of opiate addiction and are restricting the amount of painkillers they will prescribe. For instance, some are writing prescriptions for seven to 14 days instead of 30 days, he said.
"I know a lot of the medical doctors and dentists are starting to get concerned, and they are starting to dial back a bit," he said.