Different war on drugs. What can we do differently from sending people to jail . Narrator and if its working. Youre left with the most fundamental question where do you send your kid for treatment . Narrator tonight on frontline, chasing heroin. Frontlinis made possible by contributions to your pbs station from viewers like you. Thank you. And by the corporation for public broadcasting. Major support for frontliis provided by the john d. And catherine t. Macarthur foundation, committed to building a more just, verdant and peaceful world. More information is available at macfound. Org. Additional support is provided by the park foundation, dedicated to heightening Public Awareness of critical issues. The john and Helen Glessner family trust, supporting trustworthy journalism that informs and inspires. The ford foundation, working with visionaries on the front lines of social change worldwide, at fordfoundation. Org. The wyncote foundation. And by the frontline journalism fund, with major support from jon and jo ann hagler, and Additional Support from laura debonis. There are some alarming new numbers out from the cdc showing a dramatic rise in the heroin epidemic. Painkillers is an expensive habit. Many now turning to a cheaper way to chase that high. The number of heroin Overdose Deaths nearly quadrupled. Narrator its been creeping on us for a long time americas heroin problem. The sudden rise in heroin overdoses is occurring in cities big and small. Narrator overdoses from heroin and other opioids now kill almost 27,000 people a year. And the numbers keep rising. Authorities say the drug is increasingly making its way to wealthy suburbs, and into the hands of young americans. In the last 12 months, have you done speedballs . Yes. Goofballs . Yes. Heroin by itself . Yes. Last three months, have you done pain meds oxys, vicodin . Nope. And how many times have you overdosed from opiates in your life . Never. And how many times have you witnessed someone else overdose from opiates . Three times. I dont have a cooker. I got one. David took my last cooker. This isnt clean. Dude, i have cleans. Here, thats clear. Narrator kristina block says she first tried smoking heroin when she was a teenager. When i was 14, i tried heroin and it just, like, made everything feel, like, safe and okay. Did i give you enough cleans . I think i got really trapped in it, because i mean, i guess i didnt know too much about what addiction was. Thank you. And it just became so secondnature. It consumed me. Narrator she moved to injecting by the time she was 16. I was friends with this girl who was, like, 24, and she was shooting up reg. Like, thats how she did it. And i just was kind of interested in it. And i asked her to hit me one time. Narrator kristina is now seven years into her addiction. Its just so insane what this drug, like, can make you do. Like, it literally has a brain. And it shares mine, you know . Right now, how much heroin is in your system . Probably, like, 40 worth. So, what determines how much you use . Well, the number one thing that determines how much i use is how much money i have, or how much dope i have. Narrator there are many Different Reasons why people turn to heroin. Four years ago, Johnny Bousquet, 38, says he started using to cope with the breakup of his marriage. I felt like it alleviated the pain that i was going through. It just made me feel like i can make it through that moment. And then eventually, i needed it to get through every moment. Narrator johnnys mother was also a heroin addict. She was gone by the time he was 19. One day, me and my sister, we found her dead in her room with a needle in her arm. She lost her battle with heroin then. I know she loved us, and i know she really cared about us. And i would always wonder if she loved heroin more than she loved us. Narrator hes now living in a homeless shelter and struggling to stay clean. At least a few times a day, i think, man, it would be a really good time to get loaded right now. You know, you can pull through and be okay. Why dont you even just get a little bit high . Thatll be fine. And then Something Else takes over, and then next thing you know, its two days later. Ive just been, like, fighting that, you know . I cant seem to get a hold of myself no matter how hard i try. Martin smith how does the street look to you tonight . Right here its pretty quiet. When we turn the corner, it might be different. Are you taking a right, felix . Yes. Okay. Narrator as the heroin epidemic has spread, cities and states have grown desperate to come up with solutions. Here in seattle, beat cops are four years into a radical experiment to deal with drug use on their streets. Aw bleep , cops. Hate that, dont you . I want you to do me a favor. Do me a favor. Stop moving, stop moving. Okay, good, whew. Because when youre moving, i dont know what youre doing and i get. When you stop moving, i got you. Youre getting well. Not a big deal. All right, im not gonna jam you up. We gotta find out who you are, okay . Cool. The girl on the ground is getting well. Shes shooting heroin. Stop crying, babe. We dont care. Narrator these officers are making fewer arrests. They are more likely to refer addicts they encounter to social services. Wheres the syringe . cause i want to be safe. Smith so youve become a social worker. We are social workers. Smith you are social workers. Yeah. Smith but a viewer listening to you now would say, gee, youre taking an awfully. Bleeding heart . Smith . Gentle approach. We could not incarcerate these people or arrest our way out of the problem. You would arrest a person, theyd be in jail for 20 or 30 days. They would get sober. They would start using again, wed continue to arrest them. And then they would use, and continue to arrest. How much do you use a day . Like five dollars. Okay, and how long have you been using . I just got out of jail. Im not putting you in jail. Are you a meth user too . No. Do you have any desire to get on methadone and get well . Thats what im trying to do. If you have a problem, come and see me at this office. Ill give you something to eat. Ill let you call your parents. Well sit down and well have a talk. Do you still need that cooker . Yeah. Okay. Narrator the most recent surge of heroin abuse has altered our approach to addiction and our views on the war on drugs. 31yearoldmale. Hes unconscious, breathing. Cops and prosecutors and epidemiologists, Public Health nurses, county coroners. All of this is being fought by really anonymous folks all across the country because this epidemic is also the quietest epidemic. Its filled with shame. Obvious overdose. Known history of heroin use. Admitted to using heroin today. He was found unconscious, they kinda roused him, theyre gonna start an iv on him. You dont have a lot of violence, people die alone in a mcdonalds bathroom toilet. And then when the people die, when the kids die, the parents are so mortified, so ashamed that they keep quiet, too. And the thing is left to perpetrate and spread. Narrator how did this epidemic begin . Its a crisis 30 years in the making. Bottom line too Many Americans are suffering from too much pain, and doctors arent doing enough to stop it. In this country, there was a longrunning puritanical attitude towards pain. And it resulted in almost a barbaric undertreatment of pain, particularly when it came to people with cancer and in the terminal stages of cancer. There had to be better treatment for people in serious pain. So there was a whole effort to open up minds to allow hospice care and good Pain Management for people with cancer. And then that spread into aids because people with aids often had very serious pain problems. Narrator doctors had long avoided prescribing opioid painkillers for fear of addicting their patients. That changed with the emergence of the hospice movement. That movement collides with an opportunistic drug company in the form of Purdue Pharma. They see the opportunity to expand the use of these drugs beyond the cancer wards, kind of into the mainstream of medicine. And the drug that becomes the vehicle through which they do that is a drug called oxycontin. Oxycontin is one of americas new prescription wonder drugs. Its a powerful painkiller. Oxycontin was not really a new drug. The molecule had been around since 1916. What they did is they took this old, existing drug and they introduced a timerelease mechanism into it so that it would be significantly less addictive because it wouldnt be released up front all at once. Thats how they pitched it to the fda. Purdue pharma marketed it to doctors who were prescribing drugs for all manner of ailments to common, ordinary folks who were not dying of cancer. To them, oxycontin initially looked like a godsend. It looked like this wonder drug. Like, all of a sudden, we can give this, and we dont need to prescribe eight vicodin a day. There is no question that the marketing of oxycontin was the most aggressive marketing of a narcotic drug ever undertaken by a pharmaceutical producer. The fda allowed them to make the claim that, because it was a longacting drug, it might the stress being on the word might be less prone to addiction and abuse than traditional drugs. There was absolutely no science to support this idea zero. The undertreatment of pain is a major Public Health problem. Narrator to urge doctors to treat pain more aggressively, Purdue Pharma, launched a series of promotional videos. The pain that i have basically covers my neck to my feet. 34 million adults suffer from chronic pain. Narrator the company deployed prominent pain specialists like dr. Russell portenoy to ease concerns about addiction. The likelihood that the treatment of pain using an opioid drug which is prescribed by a doctor will lead to addiction is extremely low. Opioids are safe and effective medicines. The message in these programs was that real addiction in your patients treated with opioids is exceptionally rare. Less than one percent of patients. Purdue pharma managed to persuade a lot of good people in medicine that they needed to dramatically up their prescriptions of opioids. Now, part of the reason they were able to do that is that there was clear evidence there were some people in pain who didnt need to be in pain and we had underused them. Theres no doubt about that. But theres also no doubt about it that they were commercially driven. Narrator by 2001, purdue was selling more than 1 billion worth of oxycontin a year. Prescriptions for other opioids soared too, for drugs like percocet and vicodin. We went from a country that used almost no opiate painkillers, like in the 50s and 60s, to being a country where we used 83 of the worlds oxycodone, and almost 98 of the worlds hydrocodone. Its night and day. Its a stunning statistic. Narrator most of the users were white men and women living in towns and suburbs. Cari creasia, a stayathome mom living in kent, washington, was prescribed vicodin after the birth of her second child. When her prescription ran out, she wanted more. I just pursued it. I went to a doctor and i made up an ailment. I said, i have terrible migraine headaches. In order to get more, i got on the phone the next day and said, this ones not working. I think im allergic to it. Okay, are you sure . Well prescribe something different. Before all was said and done with this doctor, he was prescribing me 300 to 400 pills per month. Highly regarded by his patients, they rate him 3. 5 out of 4 stars. Narrator her prescribing physician was a doctor with top credentials. He has won a number of awards. He was a young doctor. I think he was fairly new in the field, early 30s. For a couple of years, it worked. He never once said, this is a problem. Narrator no one in her family seemed to notice. She still was functional. She would still have the facade of looking like she was completely together. Like the poster child pta mom that everybody looked up to and everybody wanted to be. Narrator during that period of her life, she says she was consuming around 15 to 20 painkillers a day. It felt that good to me, and it made me feel that comfortable in my own skin. I felt like i was a better mom, a better person, easier to be around. It made me feel like i was functioning on a higher level. Narrator the supply from her doctor remained steady for the next two years. But then one day, cari ran out of pills. He was on vacation. Nobody ever told me, now that youre taking these pills, you cant just stop. Youre going to get ill. And getting sick was kinda like truth serum for me. It made me want to talk. It made me want to reach out. So i asked my exhusband to help me. Narrator caris husband confronted her doctor about the dozens of bottles of painkillers he had prescribed. He said, i thought she was smarter than that. Youre gonna have to wean her. He scolded me. I left there feeling rather ashamed and like i had done him wrong. Narrator cari promised to stop to go cold turkey. But she couldnt. I began seeking pills in various ways, and it started with going through peoples medicine cabinets, the neighbors, people from church, family members, grandparents. I even went to real estate open houses and then asked to use the bathroom to obtain pills. If youre calling to refill a prescription and know your prescription number. And id call in refills on these medications, calling these automated lines at walgreens, posing as the nurse from this doctors office. Please refill this, go through the drivethru and pick it up. Im soandsos daughter, or friend, and shes sick. I have to pick up her script. No questions asked. Narrator after two years of stealing other peoples prescriptions, one morning, she ran into trouble at walgreens. I went to the driveup window and the pharmacist said, this isnt your script. We called the doctor. This is fraudulent. He called the police. They came to the house. Do you have small children here . Well, put them on the computer downstairs. Were not gonna arrest you if youll go and turn yourself in. So my neighbor and friend drove me down to the police station, and that became a deferred prosecution. And as a result of that, i went into inpatient treatment. More and more americans are ending up in the hospital after overdosing on prescription drugs. Narrator it was a time when the country was waking up to the opioid crisis. A National Epidemic of pill popping so bad its being called pharmageddon. Oxycontin was once marketed as something of a wonder drug, one that could stop pain without getting patients addicted. As it turns out, that was a lie, and a deliberate one. Narrator in 2007, after a fouryear investigation by federal prosecutors, Purdue Pharma admitted to charges of fraudulent marketing. The executives conceded they ignored widespread reports of deaths and addictions. Narrator the company paid 600 million in fines and settlements. Admitted they misled the public. Narrator in a statement, Purdue Pharma said they accepted responsibility and most significantly reformulated oxycontin with abusedeterrent properties. Their most prominent medical consultant, dr. Portenoy, expre. By 2009, a newly appointed team at the office of National Drug control policy was coming to grips with the magnitude of the opioid crisis. You know, all we had to do, really, was pick up the paper and just see every day, you know, there was a story about people dying or, you know, doctors getting arrested for running pill mills, those kinds of things. Shady pain clinics that will prescribe just about anything for a price. Narrator the new deputy drug czar, dr. Tom mclellan, was poring over data on overdoses. But it was outdated. One of the problems is you dont get the results of opiate overdose for three years. Theres a lag of two years. So its like driving by looking in the rear view mirror, okay . Smith so you knew that there was a rise in the prescription rates. Oh yeah, but we didnt realize that the statistics had already started to really go way, way up. Narrator at the centers for Disease Control, director tom frieden was looking at health data for the whole country. I was just stunned. The only thing that was getting worse was deaths from opiates. Everything else was getting better. But then i began looking through the whole of the centers for Disease Control and prevention and i was seeing the impact of opiates everywhere. Birth defects, neonatal abstinence syndrome. Hepatitis c and hiv. This is an unusual and horrific phenomenon. Its an emerging problem. Narrator frieden started raising the alarm. One day in the spring of 2010, frieden approached an official at the drug czars office, dr. Keith humphreys. We meet privately, and he says, you guys in the white house need to start using the word epidemic for opioids. This is an epidemic. Look at all these people dying. This is like the early parts of aids. We need to really ramp up concern about this. This is killing lots of people. Narrator the team at the office of National Drug control policy decided it was time to get president obamas attention. We said that it was going to be an even bigger problem. Smith did you see that that was gonna lead to a rise in heroin addiction . Oh, yeah. I mean, prescription opiates is heroin prep school. The inevitable thing is gonna be a reduction in the availability of those. Once that happens, you have to turn to something, and that is gonna be highpotency street opiates, heroin. Smith and did you take those warnings to the white house . Yes, we did. Smith and . Thank you for sharing. I mean, they get warnings all the time about dire things that are gonna happen. Some happen, some dont. It was not the main thing for the Obama Administration. They had a few other tiny little problems, like the Affordable Care act. Americas still reeling from the Bank Collapse and real estate collapse and all that. Little things. Push to stop a real epidemic of prescription painkiller abuse. Narrator one year later, the white house called for more prescriber education and additional prescription monitoring. Prescribing fewer pills at one time. Narrator by that time, doctors were writing enough prescriptions a year to give a bottle of painkillers to every american adult. Narrator as for cari, despite a stint in rehab, she couldnt shake her addiction. Ten years after she first got hooked on opioids, she moved out of her house, leaving her husband and two kids. She eventually started a new relationship and began a new life. But then one day, she ran into an old friend from high school. I said, im in reco