Heroin is taking a unprecedented toll on Alaska, with deaths, overdoses and medical costs sharply rising, according to a new report by the state Division of Public Health.
The 18-page report, released Tuesday, details the dimensions of the problem. It comes a week after the federal Centers for Disease Control and Prevention announced the similarly staggering results of their own survey of heroin and opiate use nationwide.
Among the findings in the Alaska report:
• The number of Alaskans who said they had used heroin in the past year quadrupled between 2002 and 2013.
• The number of heroin-related deaths in Alaska more than tripled between 2008 and 2013. In 2012, the rate of such deaths, at 2.7 per 100,000 people, was 42 percent higher than the national rate.
• The rate of hospitalizations for heroin poisoning nearly doubled between 2008 and 2012. Total medical costs exceeded $2 million.
• Between 2004 and 2013, the number of Medicaid payment requests for heroin poisoning increased almost tenfold.
• Between 2009 and 2013, heroin-related admissions to publicly funded substance abuse treatment centers nearly doubled.
The report's data also offers a glimpse at the people being hospitalized for heroin overdoses in Alaska.
Some 68 percent of those hospitalized were white and 59 percent were female, according to Medicaid patient data of people treated for heroin poisoning between 2003 and 2014. They were most likely to be between 20 and 39 years old.
None of this comes as a surprise to people who work in emergency medicine or addiction treatment.
"It's getting to be almost surreal," said Mike Crotty, the EMS battalion chief for the Anchorage Fire Department. He oversees emergency medical response in the city.
It isn't uncommon for Crotty to be called to one or two heroin overdoses in a shift, he said. His record is six.
His medics treat overdose victims who've shot up in cars, in houses littered with needles, or outside. The increase first became noticeable a few years ago, Crotty said.
"It's frightening how much we're seeing it," he said.
While the newly released study focuses exclusively on heroin, the problem is "tightly linked to an epidemic of opioid pain reliever abuse," according to Jay Butler, chief medical officer of the state Division of Public Health.
The resurgence of the drug is due to a few factors, Butler says. Heroin is both more available and cheaper than it was in the past. Combined with a tandem epidemic of prescription painkiller addiction, "it's a perfect storm," he said.
A recent federal study found that people with a history of abusing prescription opiate pain relievers were 19 times more likely to use heroin than those with no history of nonmedical use.
To counter the deaths and hospitalizations, the study's authors recommend better screening for people who may have a heroin problem, tighter control of prescription painkillers -- often a pathway to addiction -- and wider access to Narcan, a lifesaving drug that can stop the effects of a heroin overdose.
In 2014, emergency medics in Alaska used 490 doses of Narcan on patients. Several states have allowed even wider access to Narcan, providing it to police departments and even addicts and their families and friends.
Sen. Johnny Ellis, D-Anchorage, introduced a bill during this year's legislative session that would remove civil liability for doctors who preventatively prescribe Narcan to addicts and friends and family who administer it during an overdose. Senate Bill 23 passed the Senate but was stalled in the House when the session ended.
Substance abuse treatment can't be left out of the discussion, Butler said.
The report identifies four methadone clinics in Alaska and about 50 certified prescribers of Suboxone, another opioid treatment. Treatment works best when therapy is combined with medication, the study's authors say. In 2014, a total of 798 people got some kind of state-funded substance abuse help, the report says.
But people are still falling through the cracks.
"Access to care is certainly an issue," Butler said. "The number of sites and providers who are well-trained and comfortable managing addiction is fairly limited. While there are treatment options available, getting the right people to the right provider has not always been successful."
Butler says he is heartened by at least one sliver of light in a dark topic: People are talking more openly about addiction and its impacts, perhaps a step toward shedding a persistent stigma.
"This used to be the kind of thing people didn't talk about," he said. "The silence is breaking."