CAMBRIDGE — In many cases, heroin and opioid users become addicted “... quite accidentally,” according to Dorchester County State’s Attorney William Jones.

In October, members of the Dorchester Banner editorial staff met with county leaders who work in criminal justice, the health department and emergency services to discuss the opioid epidemic that is growing across the nation, its relevance to Dorchester and the area. Dec. 15, we met again with the state’s attorney to discuss the subject.

At the meeting, Donald Hall, director of the Dorchester County Addictions Program, said addicts are often stigmatized. He sometimes sees “really negative and cruel comments,” on Facebook and in social media about people who are using drugs, specifically opioids, he said.

“These are our neighbors, our siblings, our spouses, our children,” Mr. Hall said in October of people with substance use disorders. “To some extent, we’ve got to take a step back and realize that we’re not talking about some strange group of people way over there. We’re talking about the person next door or the person upstairs in the bathroom. We’ve got to realize that, and be willing to support treatment and encourage people to go to treatment. Stop frowning on people when they say they have a problem. ... I think if there was less stigma, more people would be willing to say, ‘yeah, I do have a problem,’ or be willing to step up a little bit faster and get treatment.”

Speaking at the October meeting, Mr. Jones said in most recent opioid cases he has seen as state’s attorney, opioid addiction begins with pain killers. Accidental addictions coupled with deadly consequences make for a frightening subject that needs to be addressed by the community.

“You’re talking about good, honest, law-abiding people who, for example, got addicted through their pain killers as a result of their surgery. You’re not talking about somebody who was generally living that life,” of transitioning from gateway drugs like marijuana or alcohol to more lethal drugs like opioids, Mr Jones said. “They quite accidentally found themselves here.”

Mr. Jones was a police officer from 1987 to 1996 then went to law school. He worked in a private practice then became a public defender. From there he became a prosecutor and worked as assistant state’s attorney from 2002 to 2004, senior assistant state’s attorney from 2004 to 2007, and interim state’s attorney from 2007 to 2009 when he officially became state’s attorney for the county.

At the Dec. 15 meeting, the state’s attorney explained that he has seen plenty of cases of people starting drugs like marijuana and alcohol at a younger age and eventually moving on to harder drugs like cocaine and heroin.

However, “that’s not the average person we see anymore,” Mr. Jones said.

Instead, “I call them the medicine cabinet cases,” he said. “They really sort of fall into two categories. One is the person who is lawfully prescribed a pain killer and becomes addicted. Then the other person is usually a younger person who has access to mom and dad’s medicine cabinet where mom and dad keep their Percocet or their Oxycontin or something like that in there.”

The state’s attorney said he sees cases of minors stealing a few pills out of a medicine cabinet and taking them to school or a party.

“Those are the two things that we see the most of,” Mr. Jones said Dec. 15. “It’s the first case that we really see the most. It’s a person who was in a car accident, hurts her back. They had surgery. They’re prescribed medications and they didn’t get off soon enough. It’s the person who for whatever reason was given a lawfully prescribed medication. Maybe their physician was careful in regulating what they got but then they went to another physician and they engaged in doctor shopping, that sort of thing. ... That’s a real tragedy because this is a person who was a good person.”

James Phillips Jr. has been sheriff in Dorchester since 2002. Previously, he was the chief deputy. At the October meeting, he said the cases of opioid and heroin use he encounters are different from other drug cases he has seen during his career in law enforcement.

“... For the first time in my entire career, we’re dealing with something when we’re dealing with heroin that we don’t have a set of demographics that we can look at, simply because there are none,” Sheriff Phillips said. “They don’t exist.”

Whether we are aware or not, many of us in the community, Dorchester County, the Shore and the state, know someone who is using opioids or who is in recovery. The sheriff is no exception.

“I had a very close friend of mine whose young daughter became addicted and had an overdose,” Sheriff Phillips said in October. “I watched her grow up. I knew her. You look at what’s going on and who it’s affecting, every one of these people are somebody’s son, daughter, mother, brother, sister, father.”

Anna Sierra, director of Dorchester County Department of Emergency Services, joined the October conversation. She provided statistics on Narcan use in the county. Narcan is a potentially life-saving opiate antidote that reverses the effects of an overdose. In Dorchester County, Narcan is used by both police and emergency personnel.

With next to no harmful side effects, emergency responders are trained to use Narcan based on the symptoms they see. While Narcan may stop a potentially fatal overdose, use of the antidote does not necessarily indicate the person was using opioids. As an example, Ms. Sierra said symptoms of diabetic shock are similar to an overdose, so Narcan may be used as a “tool in the tool box,” to save a life.

Ms. Sierra researched cases of Narcan use by police and EMS responders in the entire county including municipalities from October 2015 to October 2016.

“We pulled a couple hundred-plus cases,” she said. “We went through the narratives of the EMS reports to see if there was any cause,” to think opioids led to an overdose. “There was paraphernalia laying around. There was somebody who was there who reported that this person was an addict or there was a pre-existing issue or a history regarding opioid use. Once we sorted that out, we came up with 63 (overdose) cases and that is our best ballpark.”

According to Ms. Sierra, there were two spikes in opioid overdoses with 11 in April and 10 in August. In most cases, the patients recovered. In mid-August in Cambridge, there were six overdose cases within a couple days. Three of those cases came Aug. 11 alone with one resulting in death. In August, Mr. Jones said he suspected a batch of heroin laced with fentanyl made its way to the county. Fentanyl is a potent synthetic opioid sometimes mixed with heroin.

Because of the sensitivity and privacy that comes with a person’s health, and the way the county gathers information on overdoses, the exact number of opioid-related overdose cases is tough to pinpoint, Ms. Sierra said. Yet among the 63 cases with anecdotal or direct evidence suggesting an overdose related to opioid use, some of the data Ms. Sierra researched supports Sheriff Phillip’s claim that the opioid user is not a traditional drug user. Of those 63 cases, 16 people were aged 20 to 30 years, 18 were aged 31 to 40, 15 were aged 41 to 50, eight were aged 51 to 60 and six were aged 61 to 70.

“So it’s a huge range,” Ms. Sierra said. “It’s not just effecting young people or baby boomers or seniors. It’s all over the place.”

Mr. Hall, who came to Dorchester to head the addictions program in April, agreed with the other leaders in the room on how people come to be opioid users.

“It’s hitting families in areas that cocaine and marijuana didn’t necessarily hit,” Mr. Hall said. “It’s hitting kids that traditionally didn’t want to smoke marijuana or didn’t want to take cocaine, but they may have had a sports injury or got a tooth pulled, or whatever, and got exposed to the medication and from the medication ended up with drug use and addicted. ...

“Good kids, good people, make bad decisions,” Mr. Hall said. “They know what the doctor said about taking medication. But if you talk to people, how often do they say, ‘Well, I’ll take two instead of one.’ Good people make bad decisions and sometimes it ends up with a really bad result. There’s no profile for folks.”

During the October meeting, Mr. Hall said he met with staff at the Dorchester County Detention Center including Warden Steve Mills and a nurse.

“When I met with detention center personnel, they told me 80 percent of people who go into the detention center had to be detoxed,” from alcohol or drugs including opioids, Mr. Hall said. This includes every person who becomes detained at the center regardless of charges or reasons why.

Mr. Hall is looking to expand and introduce a number of programs in the detention center.

“They expressed a real willingness to work with us and I want to be clear about that,” Mr. Hall said of detention center leadership. “I was really pleased with that. They were really supportive.”

Mr. Hall said in October that 145 people were receiving treatment through the addictions program available through the county health department. This number does not account for people in the county receiving treatment through private providers.

“From where I sit, it’s a very low number,” Mr. Hall said. “I’ve been talking to my staff about people in the program as well as sending someone over to the detention center.”

Mr. Hall is working to expand public programs in the county and is collaborating with private addiction service providers including Shore Behavioral Health.

“I can’t say enough about Donald Hall and the health department’s desires to really provide services in the detention center,” Mr. Jones said Dec. 15. “We have an open-minded county government also, so I don’t believe that we will have many obstacles in terms of what we see from the detention center or in the county in implementing those changes.”

The state’s attorney said he views opioid use primarily as a health issue with a need for enforcement. Drug dealers operate an illegal business deserving of severe punishment, but users need treatment in most cases.

“People are being arrested and charged with possessing heroin. There’s no question about that,” Mr. Jones said. “To be clear, our goal with them is not giving them criminal records. It’s not putting them in jail. That’s not the end result for them. Might we have to do that sometimes? Absolutely, sometimes you have to really have some leverage over someone to get them to take advantage of that treatment that we really want them to have. The goal is not for an addict to be in jail. The goal is for them to be able to live their lives without having to use that substance. And so that’s where our efforts there are targeted.

“Finally, there are those who commit crimes in an effort to satisfy their addiction, such as robbery, burglary, theft, or any number of illegal activities. The victims in these cases deserve justice and the fact that someone’s addiction fueled the crime will not allow them a ‘pass’ in terms of how they are treated by police, prosecutors, and the courts. The need for treatment may be one consideration at sentencing, but people who commit these crimes should know that they will be held accountable.”

Editors note: This is the second part of a series of six stories about opioids, heroin and related issues in Dorchester County. The series will appear in Friday editions of the Dorchester Banner through Feb. 3.

The next story in the series will focus on the legal response to opioids as well as the life-saving efforts in the county related to the use of Narcan. Subsequent stories will highlight people in recovery and support services, both public and private.