First, she empties the gel capsule into a metal spoon. With her other hand, she grabs a water-filled syringe and squirts it into a mix on the spoon. Using a lighter, Lilly heats up the concoction until it stops bubbling.
She then picks up a small cotton ball from beneath the candy wrappers covering the bedside table and sticks it into the syringe to use as a filter.
Then she fills the syringe with the heroin from the spoon.
She hands the syringe to her boyfriend, sitting beside her on the bed. She still gets too squeamish with needles to do it herself. While she wraps an iPod cable around her arm as a makeshift tourniquet, her boyfriend sticks the needle into a vein just below her elbow. He pushes down the syringe and the heroin rushes into her veins.
Lilly, a senior public health major whose name has been changed to protect her identity, shoots up every day after getting back from class, often driving 45 minutes to Baltimore in the afternoon to score.
Heroin addiction among people like Lilly has skyrocketed in this state in recent years, and record-high overdose deaths prompted Gov. Larry Hogan to create a statewide task force in February.
Heroin-related deaths have grown steadily every year since 2010. In 2013, the 464 people who died from heroin in this state outnumbered homicide deaths by more than 75.
In Prince George’s County, heroin deaths have doubled in the past four years. The 26 deaths between January and September of 2014, the last reported time frame, matched the county’s highest death rate for any full year in the last decade. Heroin-related emergency room visits have more than tripled since 2010, with 1,200 statewide.
During his campaign, Hogan vowed to declare a state of emergency after learning how widespread heroin addiction had become across the state.
“I know the devastation it can cause for families and communities,” said Hogan, who lost a cousin to a heroin overdose, at a press conference in February. “Everywhere we went, we were saddened by stories of how just under the surface of every community, heroin was destroying lives.”
Laura Place, coordinator of substance use intervention and treatment programs at the University Health Center, runs the Recovery Support Group on the campus and said she noticed an uptick in heroin users over the last few years. She said 13 opioid users have come to her group this year, but those seeking treatment only represent a small percentage of regular users.
University Police spokesman Maj. Marc Limansky said he cannot recall any heroin overdoses occurring on the campus in his 26 years with University Police, but because of the statewide increase, they are preparing their response in case an overdose does occur.
“We’re concerned about the use of opiates or heroin,” Limansky said. “We’re not immune from that, certainly, and I don’t think it’s a matter of if we’re going to see one occur here, whether it comes off the campus or on campus, we need to be able to help an individual suffering from an overdose.”
Lilly said she has come close to overdosing before. Her friends say her eyes have rolled back in her head and she has vomited right after shooting up, which happens far more often than it should, she said.
“If you have a high tolerance, sometimes you’ll be like, ‘Oh let’s do a little bit extra,’ and sometimes it doesn’t make a difference, but sometimes it does and you end up doing too much,” she said.
But even after experiencing close calls, hearing devastating stories and seeing statistics on overdose deaths, Lilly said she still can’t shake the habit she developed last summer.
(James Levin/The Diamondback)
It started with painkillers during summer 2013. Lilly’s friend had a prescription, and she enjoyed the euphoric high she got from opiates.
An occasional pill turned into a daily habit, and she moved from swallowing pills to crushing them up and snorting the powder. Eventually it became more cost-effective to shoot up, at only about $10 a dose, so last summer she moved on to heroin.
At first, the drug gave her a euphoric sensation — “better than any food or sex or anything,” Lilly said.
But since shooting up became an everyday occurrence, she says she rarely gets high anymore and only uses heroin to get rid of her daily sickness, which ranges from nausea to vomiting and diarrhea, and get herself out of bed.
“If you are really used to it, you sort of end up just feeling normal from it,” Lilly said as she puffed on a cigarette and looked out over McKeldin Mall. “Instead of feeling all depressed and s—– you feel how you imagine other people are feeling all the time. It’s pretty awful, actually.”
Lilly’s shift from popping pills to injecting heroin is becoming increasingly common among drug users at this university, Place said.
“There really is not a line, except for socially, between using Oxy and using heroin,” Place said. “A lot of people that I’ve spoke with who end up using heroin switch to shooting up instead just because it’s cheaper.”
The heroin epidemic has spread in large part due to the state’s crackdown on prescription drug abuse, said St. Mary’s County Sheriff Timothy Cameron, a member of the state task force. As stricter enforcement limited access to pills and drove up prices, he said, drug users chose heroin as an alternative.
“Perhaps we’re a victim of our own success in that regard,” Cameron said. “Not that there’s not still opiate pill abuse going on, but heroin is plentiful and cheap.”
Place said heroin, in its pure form, is no more dangerous than prescription opiates such as Oxycontin, but street drugs are more likely to be tainted, and injecting with dirty needles can spread disease or infection.
Lilly said she used to take more precautions when she started shooting up, but as her addiction grew, she became more careless.
“I said I would never share needles. I did that,” Lilly said. “I said I would never share water. You’re not supposed to share anything, cotton or anything like that. I’ve shared everything.”
Using heroin every day for close to a year has taken a toll on Lilly. She usually feels too sick to get out of the bed in the morning and has to take Zubsolv, a prescribed medication for dealing with opiate withdrawal, after waking up or throughout the day.
She has no appetite, so her diet consists mostly of candy. Her only free time outside of her 16-credit course load is spent shooting up or driving to Baltimore to pick up from her dealer. Because she doesn’t have a job, she uses the food money her parents give her to buy drugs.
“The hardest part is managing when I can go to Baltimore and pick up,” she said. “The idea is you go before rush hour, because after rush hour it gets dark, and if you have a taillight out you’re definitely going to get pulled over. Money’s really hard, also. I could easily spend $50 a day just on myself.”
The only people who know about her addiction are the three friends she uses with, who she says are graduate students, and some of her close friends from high school. She once mentioned using heroin to a friend from class this year she was smoking weed with, but Lilly said the friend became judgmental, and they soon drifted apart.
(James Levin/The Diamondback)
As she walks around campus, she says she feels like a normal, functioning student and doesn’t think anyone would guess her secret. But she’s afraid to wear short sleeves for fear of people seeing her scars.
Lilly said her doctor told her that because she surrounds herself with people who also use heroin, the only realistic way for her to quit is to stay at an in-patient rehabilitation center.
Kathleen O’Brien, CEO of Walden Sierra, a rehab center in Southern Maryland, said the most dramatic surge of addicts they’ve seen in recent years has been 18- to 24-year-olds, especially young women.
“It’s much more common than we would ever think to imagine,” O’Brien said. “There are many people both in colleges and in the workplace that are addicted to opiates, some to prescription opiates and others to heroin.”
O’Brien, who testified in front of the state task force at the Southern Maryland Regional Summit last week, said heroin addiction needs to be viewed as a public health crisis rather than a criminal issue.
“We’re not going to be able to incarcerate our way out of this issue,” she said. “The first thing we have to do is understand that it’s a brain disease and it’s a chronic disease, so we’re not going to have a quick fix.”
Graduation scares Lilly.
Skipping lectures and the occasional lab is one thing, she said, but a job would force her to be present and productive every day, no matter how sick she feels. She fears she might not have time to drive to Baltimore to pick up the drug, and she worries about managing her money without help from her parents.
“One thing I’ve been discussing with my friends is, like, once I graduate, it’s not going to be so cute anymore to be a college student doing drugs,” she said. “Then it’s like you’re an adult and you’re a drug addict. That’s not fun.”
Place, the health center addiction counselor, said a new treatment method called opiate replacement therapy — such as the Zubsolv pills Lilly is prescribed — has been effective in preventing withdrawal and waning addicts off the drug.
(James Levin/The Diamondback)
But addiction can’t be cured with medicine alone, she said.
“Obviously, there’s a lot more going on in someone’s life once they’ve developed addiction to a substance than just the substance,” Place said. “Usually their support networks are not necessarily as strong as when they first started. Often some other things in life have not been going so well, and dealing with those stressors can be difficult.”
The governor’s task force is holding regional summits to learn more about the heroin epidemic before developing a strategy to combat the problem. The group is tasked with submitting recommendations by the end of the year.
O’Brien recommended a five-pillar approach to combating heroin addiction: community-based education and prevention services, harm-reduction strategies, law-enforcement practices that focus on alternatives to incarceration, more funding for treatment infrastructure and drug-free workplace policies.
“It’s partnering primary care and behavioral health and substance-abuse people with law enforcement, with courts and with education,” O’Brien said. “It’s going to take the entire community to wrap around this issue to make any change.”
Lilly has tried to quit before.
Last month, she had to have minor surgery to remove an abscess on her forearm where she injects the needle. The hospital visit was painful and scary, she said. She kept clean for two or three weeks, but eventually fell back into the habit.
“When you’re in withdrawal and feel really s—- about yourself and everything, it’s not even the physical effects as much as the mental effects,” she said. “You start feeling really bad about yourself and using and you say, ‘Well, I’m a f—– junkie anyway, so why not keep using? At least I’ll be happier for one more day.’”