Cases are showing up more frequently than ever here -- in hospitals, treatment centers, jails and morgues.
Heroin abuse is rising in Minnesota, and the drug is presenting health and law enforcement officials with a three-part problem: It's inexpensive, easily available and deadlier than ever.
"In Minnesota, heroin is everywhere," said Carol Falkowski, drug abuse strategy officer for the Minnesota Department of Human Services.
In the past decade, the percentage of treatment-center admissions for heroin addiction has doubled in the state, from 3.3 percent in 2000 to 6.7 percent in 2010, according to state records. Heroin-related visits to Twin Cities emergency rooms rose from 1,023 in 2005 to 1,855 in 2009.
Among men tested for drugs upon entering the Hennepin County jail last year, nearly 10 percent were positive for heroin or other opiates -- the third consecutive year that percentage increased, Sheriff Rich Stanek said.
Minnesota's heroin cases now exceed the state's methamphetamine and cocaine cases combined, according to state records.
Anoka County Medical Examiner Quinn Strobl said that when she came to the office in 2005, it was a rarity to see heroin.
"But I just had two heroin overdoses in Anoka County within a week and a half," she said recently.
The problem shows itself in ways beyond numbers. Strobl, who serves as coroner to 19 counties in Minnesota and western Wisconsin, told of one woman who said she couldn't understand how her daughter died of an overdose, that her daughter had been such "a responsible heroin user." Strobl recently heard another parent speak almost matter-of-factly about losing a child to heroin.
"I try to tell them that when you're injecting something in your body that you buy on the street from an illegal source, you can't be responsible," Strobl said.
Two years ago, Dr. Lindsey Thomas, the Dakota County medical examiner, could confirm only one heroin-related death in the counties she oversees. Last year, there were nine. This year, through April, there had been at least five more.
"Heroin is appearing on our radar screen a lot more often than it did five or 10 years ago," Anoka County prosecutor Bryan Lindberg said. Part of the reason, he said, is that it's relatively affordable.
It's also more lethal than ever.
Some Twin Cities heroin, which authorities believe originates from Mexico or Southwestern states, is nearly 60 percent pure, according to a federal Drug Enforcement Administration study released last year. In no other U.S. metro area is heroin close to being that potent. In St. Louis, which Falkowski says has been a historic trouble spot for heroin, the drug is 3 percent pure, according to the DEA. In Seattle, it's 19 percent. In Houston and San Antonio, it's 7 percent.
The higher the opiate's purity, the greater likelihood of overdose death, Falkowski said.
"It's getting worse," said Stanek, the Hennepin County sheriff. "Go back 25 or 30 years and the only way to take heroin was to inject it. Now, kids smoke it, cut it, mix it. They've come up with new ways to OD."
Recently, when Falkowski and an audience of drug experts, physicians, law enforcement officers, counselors and parents listened to a 20-year-old recovering addict discuss heroin use at a seminar in St. Paul, the young man was asked how he discovered heroin. He said he was 14 at the time. Other than marijuana, it was the least expensive drug he could find.
"It's a potent, cheaper alternative," said Dr. Gavin Bart, director of addiction medicine at Hennepin County Medical Center and professor of medicine at the University of Minnesota.
"More bang for your buck," Daniel Douglas, a detective with the Anoka-Hennepin narcotics and violent-crime task force, said of the heroin circulating in the Twin Cities.
"This is a tough, tough drug to investigate," Douglas said. "Heroin addicts, generally, aren't the ones committing violent crimes or assault. It's not about partying. These people want to live, so they can feed their addiction."
It's a behavior with staggering patterns of relapse, an addiction that can strike anyone curious enough to try heroin just once.
"Social demographics may influence your exposure to a drug, but after that first try, it's an equal playing field," Bart said. "Once addiction comes in to play, choice is no longer an option."
Paul Levy • 612-673-4419