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The number of people dying of heroin overdoses in the St. Louis region has increased exponentially in recent years. To gain some perspective on a painful problem without an easy answer, St. Louis Public Radio offers an in-depth look at what caused the epidemic and the human toll it's leaving in its wake.  

The St. Louis heroin epidemic: How did we get here and how do we stop it now that it’s here?

Michael and Kelley McDonald and Laura and Pete Stenger reminisce about their sons Sean McDonald and Mitch Stenger at Cottleville Wine Seller in St. Charles County. Both Sean and Mitch died of heroin overdoses in 2014. Mitch used to work at the Wine Seller
Camille Phillips | St. Louis Public Radio
Michael and Kelley McDonald and Laura and Pete Stenger reminisce about their sons Sean McDonald and Mitch Stenger at Cottleville Wine Seller in St. Charles County. Both Sean and Mitch died of heroin overdoses in 2014. Mitch used to work at the Wine Seller

(Part 1 of 3) - On an April morning in 2014, Kelley McDonald woke up in her suburban St. Charles home and went downstairs to remind her son Sean to take his bipolar medication.

“I go over to the couch and I kind of shake him and I’m like come on buddy you’ve got to take your medicine. And that’s when I looked at him and he was kind of blue and I started screaming,” said Kelley McDonald, her voice shaking as she sits next to her husband Michael at a restaurant gazebo one year later.

Sometime during that April night, their 21-year-old son had fallen asleep after snorting heroin and slipped into death, unable to take a breath.

Sean McDonald with his sister and parents before his death of a heroin overdose in April 2013.
provided by the McDonald family

The McDonalds shared their story with St. Louis Public Radio in hopes that fewer parents have to experience what they and at least 2,397 families in the region have experienced since 2007: the loss of a loved one to an addiction to heroin or prescription opiates such as oxycodone or fentanyl.

According to county coroner data on opiate overdose deaths collected by the St. Louis area National Council on Alcoholism and Drug Abuse, the number of opiate deaths in the region has nearly tripled since 2007.

And according to the Centers for Disease Control and Prevention, the heroin epidemic has caused more deaths in the Midwest than anywhere else in the country, claiming four times as many deaths in 2013 as it did in 2000. 

The rising death toll begs the question: Why are so many more people dying now and what is being done to reverse the deadly trend?

Why are more people dying now?

As special agent in charge of the Drug Enforcement Administration in St. Louis, it’s Jim Shroba’s job to track drug trafficking trends. According to Shroba, the problem is an overabundant supply of heroin that has sprung up in response to competition between Mexican and Colombian drug cartels.

“We’ve seen this sea change, if you will, that began in 2008,” said Shroba. “In 2008 the average purity of heroin on the streets of St. Louis was about 11 percent. You could buy a $10 or $20 button of heroin and it would be about 11 percent pure.

“Steadily and alarmingly since 2008 to the present day, the average purity is 42 percent. … And it’s not uncommon for the DEA to seize heroin that is in the 90 percentile range.”

Jim Shroba is Special Agent in Charge of Midwest Division of the Drug Enforcement Administration based in St. Louis.
Camille Phillips | St. Louis Public Radio

Shroba said after Mexican cartels began planting more of their own opium poppy fields and producing more of their own heroin instead of just transporting Colombian heroin over the border, the purity of the heroin on the streets of St. Louis dramatically increased.

“Beginning in 2008 with the purity going up, we saw that as a direct effort on the parts of the cartels to bring in an overabundant supply (and) provide it at high purity rates so they could develop a whole new user base,” said Shroba.

The higher purity opens the drug to a wider market because it allows a user to get high from snorting the drug, removing the barrier an aversion to needles might afford.

“To get high you don’t have to shoot it anymore,” said Shroba. “In 2008 if you would have asked anybody (heroin) is an inner city drug (used) primarily by addicts that inject via the needle. … Now what we have is suburban users—high school, late teens, early 20s, and they’re snorting it.”

At the same time, the higher purity makes it much more likely that a dose is lethal. If addicts accustomed to 11 percent purity unknowingly take heroin that is 42 percent pure, a dose they expect to make them high could leave them dead.

Heroin and other opiates are especially deadly drugs because a high enough dose stops the heart and slows breathing to a standstill.

What’s being done to reverse the trend?

Under Shroba’s leadership, the St. Louis division of the DEA is partnering with state and local law enforcement to form heroin task forces that can arrest drug traffickers at all levels of an organization.

“We’re looking at heroin traffickers at all levels that are responsible not only for the distribution of heroin but they’re the ones behind weapons trafficking and the crime that affects small communities, whether that’s in the city or out in O’Fallon or St. Peters,” said Shroba. “(The departments) come to us (and say) here are the five people in this community, here’s five here, 10 here, we put that list together, we determine what intelligence information we have about these people, work with the FBI for instance, and say OK we’re going to go after these individuals in a methodical fashion because they’re the ones that are creating the crime and the instability in these communities.”

According to Shroba, the DEA has always worked in collaboration with state and local law enforcement, but rather than forming short-term projects these initiatives have become permanent and formalized.

St. Louis had its first glimpse of this type of initiative in June, when more than 50 people were charged with heroin trafficking in St. Charles County.

St. Charles County Prosecutor Tim Lohmar announces charges for more than 50 people for trafficking heroin on June 10, 2015.
Camille Phillips | St. Louis Public Radio

At a news conference announcing the arrests, St. Charles County Prosecutor Tim Lohmar said the high number of heroin-related arrests was “unprecedented for us as a law enforcement community” and likely set a record.

Still, the St. Louis region is a long way from pulling free of the hold of drug cartels. Those 50 arrests focused on just one county in the region and didn’t root out all players involved with drug cartels in St. Charles.

To Sean McDonald’s father, the arrests were a start.

“I understand they have to build cases and things like that but it would be nice to get 50 more off the street because there will be 50 more behind them,” said Michael McDonald when the arrests were announced.

The drug trafficker who came to the McDonalds’ house and gave Sean the heroin he overdosed on has not yet been charged.

To Shroba of the DEA, the goal is to reduce the number of overdose deaths and decrease the availability of the drug in the region.

“I’ve said it before: we’re not going to arrest our way out of this. Now we will arrest the biggest and baddest dope dealers that are in this game right now, and they’ll go to prison, but in doing so we have to make sure there’s not another generation of dope dealers coming in right behind them,” said Shroba, adding that the way to stop another generation is to disrupt the drug cartel’s organization as a whole.

Kelley McDonald brings her son Sean's dog Sadie along on heroin awareness walks. Sean McDonald died of a heroin overdose in April 2014.
Camille Phillips | St. Louis Public Radio

In the meantime, efforts are underway to educate parents and teens all across the region about the dangers of heroin.

In Madison County, Illinois, for instance, a task force of parents and law enforcement holds assemblies describing the risks of heroin in area high schools. Other counties, schools, and nonprofits are also working to get the word out.

And a group of families in St. Charles led heroin awareness walks. The McDonalds are part of a group in St. Charles, along with Laura and Peter Stenger (brother of St. Louis County Executive Steve Stenger). Their son Mitch Stenger died of a heroin overdose in December 2014.

Sitting in the restaurant gazebo back in Cottleville, the two couples said they want parents to know the signs to look for in their children.

“Because parents think oh that’s not in my neighborhood, or that’s not my child,” said Kelley McDonald.

“I’m telling you the pain pills truly are a stepping (stone),” replied Laura Stenger, pointing to the importance of parents keeping track of their prescription drugs.

“You have to know that even though you know your kid is a good kid he might be taking them out the back door and selling them,” added Michael McDonald. “Parents don’t realize that and they, like us, think oh maybe I took two. Maybe I took three … you never think your kids are doing this.”

Lawmakers in Missouri and Illinois have also tried to make policy changes, with mixed results.

In part two of St. Louis Public Radio’s three-part series on the region’s heroin epidemic, reporter Rebecca Smith will take a look at a failed effort to put the antidote to a heroin overdose into the hands of friends and family.

Follow Camille Phillips on Twitter: @cmpcamille.

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