Another was 32 and found dead, at home, in the bathroom last month.

A third was 62, also found dead in bed by family.

Lewiston and Auburn police are investigating the three possible fatal heroin overdoses between March and May, waiting for toxicology results and possible charges. Police say the deaths are too spread out to have been one bad batch.

But then, it’s heroin. It’s all bad.

And it’s on the rise in Maine, again.

Heroin killed three times as many people in 2012 than it did in 2011 in Maine, according to numbers from the Office of Substance Abuse and Mental Health Services.

Maine Drug Enforcement agents around the state made 99 heroin busts in the first five months of 2013 after counting 127 for all of last year.

Numbers also show more heroin addicts checking into treatment here. One-quarter report they’ve shared needles. The state epidemiologist worries about users spreading hepatitis and HIV and catching infections that can go straight for the heart. Law enforcement officers worry about patting down suspects and getting pricked.

“We’re seeing a lot of heroin,” said Dr. Michael E. Kelley, chief of psychiatry at St. Mary’s Regional Medical Center in Lewiston, which has inpatients and outpatients in its chemical dependency detox program.

At the root is economics, with deadly implications.

About 15 years ago, Kelley said, doctors received a subtle message regarding pain meds: Start prescribing.

“The federal government put a mandate of ‘adequate pain management’ onto every doctor and would actually start citing doctors during their surveys if their patients said they weren’t getting enough pain control,” Kelley said. “It turned a lot of doctors’ management of pain around, from, ‘I don’t want to give narcotics to patients’ to, ‘Oh, my god, I better give them narcotics, otherwise I’m going to get in trouble with the federal government.'”

He added, “(It) sort of changed a lot of the way we prescribe, unfortunately. Now we’re swinging in the other direction.”

With safeguards like the Maine Prescription Monitoring Program, doctors are tightening up potential drug abuse and diversion (patients taking pills and selling them on the street).

The number of prescriptions for oxycodone and other synthetic opiates in Maine dropped from 391,972 in 2011 to 379,659 in 2012 and illegal oxy has become more expensive.

Heroin has stepped in as a cheaper alternative. Cheaper but inconsistent.

“There’s no such thing as ‘good’ heroin,” said Matt Cashman, MDEA supervisor for Androscoggin, Oxford and Franklin counties. “You may be using three bags of heroin at 25 percent purity levels and you’re normally getting your supply from a specific individual, but that individual may be out and you’ve got to go to alternative B and you buy the same three bags of heroin and the purity levels are now 50 percent, so realistically you’re doing twice the dosage.

“That’s where you’re getting your overdoses,” he said.

Breaking point

In Maine, heroin was blamed for the deaths of roughly six people in 2010 and 2011, according to an April report for the Maine Office of Substance Abuse and Mental Health Services.

In 2012, that jumped more than threefold to 21 deaths. (The figure is based on heroin being the primary drug or one of the primary drugs.)

Methadone, oxycodone and benzodiazepines killed more people, but those numbers have declined or held fairly steady the past three years.

The death toll for the current year isn’t clear yet.

So far in 2013, more than 1,100 people have sought treatment for heroin addiction, compared to 2,241 for all of last year.

Guy Cousins, director of the Office of Substance Abuse and Mental Health Services, said people arrive at heroin through different avenues. Some start with alcohol, then use marijuana and cocaine, ultimately trying cocaine or heroin intravenously. Others start with a prescription opiate, get hooked and when that source dries up, they turn to the street.

Black-market oxy pills are selling for $30 to $45 each, heroin for $25 to $30 for a 0.1-gram bag, Cashman said.

Addicts can hold down jobs and raise families, Cousins said, but often not for long.

“At some point, there’s typically a break point where the amount of money one needs to be able to maintain staving off withdrawal symptoms requires a tremendous amount of assets and juggling,” he said. “It’s an eventuality that at some point, that’s not going to be working anymore.”

People enter heroin treatment both voluntarily and not, at an average age of 31.6 for women and 33.2 for men. This year, more are reporting that they have dependents (845 year-to-date compared to 636 last year) and more are reporting that they’re pregnant (12 percent year-to-date compared to 9 percent last year).

“Every time I admit somebody I’ll say, ‘What do you use?’ and they start listing the Percocets, the Vicodins, the oxycodones and the OxyContins, and heroin has joined the list on a significant portion of my patients now,” Kelley said.

Five years ago, there weren’t nearly as many.

It’s not just a matter of using, it’s also how.

According to intake numbers, 83 percent of people admitted for heroin treatment say they only use the drugs by needle. One-third of them have shared needles.

“The hepatitis rates in Maine for IV drug users was up way beyond 30 percent of all IV drug abusers last survey I saw,” Kelley said. “Somebody who ends up dying from these illnesses ends up costing the system tremendously. Liver failure is a horrible way to die, and unfortunately a tremendously expensive way to die because it’s not a quick death.”

Risks extend beyond users: Hepatitis B and C and HIV can be caught by needle and spread by sex. “There’s a significant societal issue with that,” he said.

State epidemiologist Stephen Sears said there’s also the heroin itself to worry about.

“Heroin is not sterile,” Sears said. “(Dealers) are often mixing it with something that is not sterile. The people who do it don’t really know about sterile techniques. You can see infections of the skin and then you can see bacterial infections; they’re potentially injecting bacteria.”

‘Maybe we’ll get lucky’

Roy McKinney, state director of the Maine Drug Enforcement Agency, said heroin gets to Maine along the same smuggling lines as cocaine and marijuana, up from South America. It’s diluted several times along the way by traffickers looking to increase profits.

Dealers frequently drive from big New England cities, selling along the I-95 corridor.

“They’ll come up, sell the drugs, then go back with the money to their source of supplies and then they turn right back around,” McKinney said. “A single bag in southern New England may sell for as low as $5; they may get $25 to $30 up here for that one bag. It has to do with supply. They’ll charge whatever they feel they can get away with. Of course, the more you purchase at any one time, the better the price is going to be, just like in any business.”

To afford it, Cashman said, users are known to resort to prostitution, theft and burglary. 

“There’s always a direct correlation with the number of our property crimes in relation to our drug problem,” Auburn police Deputy Chief Jason Moen said. “A lot of the burglaries that we experience and a lot of the motor vehicle burglaries we experience, it’s all driven by drug addiction for the most part. They’re stealing stuff to sell or pawn to get the money for their dope.”

The 32-year-old who died in Auburn of a suspected heroin overdose on May 4 had few contacts with police. That wasn’t the case in Lewiston.

The 39-year-old man who died March 19 and the 62-year-old who died March 28 “both had several involvements with the police, including past drug violations,” Lewiston Lt. Michael McGonagle said.

The state’s record with the drug makes the future difficult to predict. According to admissions, 2,040 people sought heroin treatment in 2003 before that number dipped. It rose to 2,247 in 2009, dipped, then rose again last year.

“I think we’ve done a much better job at controlling the narcotics coming out of the doctor’s offices,” Kelley said. “Right now, there’s a bump in heroin. It could go one of two ways: Theoretically, it’s easier to start with a pill when you’re young. If you’re 19 and for the first time somebody offers you a pill, ‘Oh, yeah, I’ll take a pill, it’s a medicine.’

“That same 19-year-old might not grab a needle and shove it in his arm,” he said. “So maybe we’ll get lucky, who knows. Maybe the next five or seven years pass and maybe less people will get addicted. That would be a blessing, as the pills become harder and harder to come by.”

kskelton@sunjournal.com