Highway to Heroin 

Long before heroin overtook him, Josh Graham swallowed a single, legally prescribed Lortab pill. It was meant to kill his pain after a wisdom-tooth extraction, and it worked. During the next year, Graham, 23, says he “abused Lortab casually. I took it to get drunk easier at high school parties.”

A friend soon talked him into trying oxycodone, better known by its trade name, OxyContin. “I was drunk at the time. But it was the most euphoric feeling I could ever have. The high was unbelievable. I didn’t have a care in the world. All my problems went away,” Graham says, who asked his real name not be used because he fears revealing his identity could harm his ability to keep his job.

Back then, Graham’s outward life seemed to be carefree. He had completed half of the classes for his bachelor’s degree at a Utah university and held a job at a big corporation. Through the friend who first introduced him to OxyContin, he started buying a 40-milligram pill to split with another friend on weekends. “I never thought I’d get addicted,” he says, “because I thought I was smart about it.” He started using OxyContin once during the week, and then several times a week. Finding a way to get the drug legally was impossible. Graham had made fake ID cards in the past, so it wasn’t too far a jump to the next side project: He would get Oxy by forging his own prescriptions. “I knew a pharmacist who wouldn’t question it,” he says. “Once I had a lot of them in my possession, my goal was to sell them for a dollar a milligram–$40 for a 40-milligram pill.”He conned himself into thinking everything was fine. The word “addiction” wasn’t in his vocabulary. “Every day, as soon as I woke up, I’d have some. I figured everything was OK, as long as I used before work and school. I was using at night and again in the morning.” Graham says the “the money was going well and school was something I was good at.” He tried to forge as few prescriptions as possible, he says, because it was stressful, and he didn’t want to get in trouble. Soon enough, none of that mattered. Graham’s story is playing out routinely all over the state. Eventually, like so many others addicted to painkillers, Graham couldn’t get enough pills to keep up with his own relentless demand. His highest intake was eight pills of 80 milligrams each—more than 640 milligrams of oxycodone–in a single day.

Just 18 months after his foray into painkillers, when scrounging for prescriptions was too much effort, Graham began snorting and smoking heroin. He could find it easily on the streets, it required no prescription—forged or not—and its supply was endless. “[Heroin] was so much cheaper, and no one ever ran out of heroin,” he recalls.

In the past decade, admissions for heroin-addiction treatment have climbed 8 percent in Salt Lake County, Eric Schmidt says, associate director of Salt Lake City’s Odyssey House, a private nonprofit rehab center for substance abusers. State-funded treatment facilities admitted 1,232 heroin addicts last year; 224 were admitted for treatment with other opiate addictions (primarily oral painkillers).

Because the statistics do not include admissions to private treatment centers, experts in Utah’s treatment community believe the numbers of opiate addicts are much higher, and that only 20 percent of those who need treatment are getting it. Drug counselors estimate up to 6,000 people in Salt Lake County are addicted to opiates but haven’t sought help.

“They don’t think they’ll have the money or don’t have access or feel they are not ready yet,” Schmidt says. “Maybe they haven’t gotten in trouble about drugs or don’t have anyone coercing them into treatment.” Because they are both opiates, oxycodone and heroin share similarities in the high they create. But its cheaper cost and wide availability make heroin an easy second-choice for people who can’t keep up the struggle to forge prescriptions or dream up other ways to get their hands on oxycodone. Long-term painkiller addiction also requires bigger doses to achieve the same high, which means more expense and logistical maneuvering.

Increasingly, they turn to heroin.