Third in a series

Carried from a car and left on the sidewalk outside a hospital emergency room, you are experiencing a heroin overdose.

Delirious and drowsy, your blood pressure is low and your breathing is shallow. Your stomach spasms and your muscles cramp. You're alone. You hope someone will spot you and alert the medical staff.

Dr. Robert Strony, an emergency department physician for Geisinger Health System, has witnessed the scenario in Danville and, more often, in Wilkes-Barre.

The frequency of drug overdoses at Geisinger's emergency rooms has remained constant, he said.

What changes is the drug of choice. Pain pills have remained a steady cause. Of late, there are more and more cases involving heroin.

You're placed in a room and immediately hooked to continuous cardiorespiratory monitoring. After an assessment by a nurse and physician, an IV is established, and oxygen and fluids are administered.

An EKG is performed.

It's a severe case. The drug Narcan is administered to reverse the heroin's effects. It works. You avoid having to be hooked to a ventilator.

Strony said overdose patients who are helped by the reversal agent usually have one goal: getting discharged.

"A lot of times the first words are, 'I want to leave.' We have no legal power to stop them as long as they're not suicidal or homicidal, and often times that's what they do," Strony said.

In a few cases, patients are so frightened by an overdose they ask for help. Emergency department staff can refer them to treatment options. More often, they simply leave.

'Getting dramatically worse'

Treatment professionals confirm what many locals in the greater Shamokin area believe: abuse of heroin and prescription pain killers is on the rise.

There have been five confirmed drug overdose deaths to date in Northumberland County this year, many a result of mixed drug toxicity of substances such as morphine and fentanyl, according to James Kelley, Northumberland County coroner.

Another three cases are pending the results of drug toxicity testing. Should all three return positive, that would raise the total in-county overdose deaths to eight in less than five months. Ten years ago, Kelley said, two or three deadly overdoses in an entire year was considered abnormal.

Six in 10 people seeking treatment at Geisinger's Marworth Chemical Dependency Treatment Center abuse heroin and pain pills. That's up from 4 in 10 in 2011, according to Dr. David Withers, addiction medicine specialist.

Eight in 10 people referred to Northumberland County Drug and Alcohol have an addiction to heroin and pills. There have been 800 chemical dependency referrals for all substances since July 2013. Glenda Bonetti, the county's drug and alcohol director, said there were fewer than 300 such referrals just three years ago, many of which were for alcohol.

"There's been an epidemic of prescription opioid abuse that appears to be getting dramatically worse," Withers said. "Increasingly, there is more and more heroin around. ... Heroin has become cheaper and more available in many regards than the prescription opioids. People, if you will, grow into heroin from Vicodin, Percocet, Oxycontin, whatever it might be."

Drug abuse will be the topic of an awareness expo to begin at 6 p.m. Thursday in the auditorium of the Shamokin Area Middle/High School, Coal Township. Doors open at 5 p.m. Treatment counselors, representatives from area treatment centers, along with officials from local and state law enforcement and government entities will be on hand. There will be first-hand accounts shared about the dangers of drug abuse.

Parents: Be vigilant

Aside from overdoses, Strony said drugs are more frequently detected in the systems of trauma patients treated after car crashes and ATV accidents. The mandated blood testing often finds alcohol and marijuana, the most popular substances, along with cocaine, prescription pain killers and heroin.

Emergencies involving narcotics occur often when you'd expect: nights, weekends and holidays, especially in the summertime.

Strony said he once treated a girl who had been a straight-A student and wanted to be a dentist, but had gotten caught up in the wrong crowd. She experimented with drugs, got hooked and overdosed, which is when Strony found her. One urine test detected three separate narcotics in her system. She lived.

Parents must learn to identify the warning signs early: waning involvement in school, withdrawal from hobbies, new friends. Money may go missing. It's paramount that parents remain vigilant, he said.

"Once they become an addict, especially with heroin, it's very difficult to turn around," Strony said. "There's a lot of people who end up dying. Even people who get to rehab tend to relapse."

Disease of isolation

An increase in addiction in a community logically widens the scope of impact.

On average, seven people are deeply affected by the actions of a drug addict, Withers said. Shifts within the family structure occur, perhaps without understanding. This can result in an exhaustive, defeating experience for relatives struggling to help an addict get clean. They end up needing support themselves.

Withers likened it to a fading photograph of an addict and loved ones. As the addiction grows, it erases each loved one individually over time until the addict is alone. He calls it a disease of isolation. Parents lose children, siblings lose each other.

"My heart goes out to family members because it's a family shredding disease," Withers said.

Between 1,300 and 1,400 patients are admitted annually at Marworth. Mondays are family days at the clinic. Relatives are actively involved in the treatment process to the point where they spend time with counselors themselves.

There is no cure-all for addiction, but there are pathways to avoidance. An active lifestyle involving athletics, music, education and theater can work. Simple involvement in another's life helps, too - asking how someone's day was and being truly invested in the answer.

"An ounce of prevention is worth 5 pounds of care," Withers said.

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