Deaths by overdose

The state of South Carolina tracks deaths by overdose. Causes of death by overdose are not exclusive, a department spokesman explained. For example, it's possible to die from both a cocaine and alcohol overdose. In that case, both causes would be listed on the death certificate.

Heroin

2008 8

2009 15

2010 14

2011 10

2012 13

Cocaine

2008 103

2009 80

2010 75

2011 61

2012 49

Alcohol

2008 22

2009 31

2010 25

2011 29

2012 27

S.C. Department of Health and Environmental Control

Mike had dabbled in a pharmacy's worth of drugs by the time he first tried heroin during a tour in the Navy 30 years ago. He considered himself to be a man who knew his limits.

Victims of heroin

Philip Seymour Hoffman was the latest in a long line of musicians, actors and artists who have died from a heroin overdose. Here a few of the more famous ones:

Cory Monteith

The "Glee" star died at age 31 on July 13, 2013, in a Vancouver hotel room from a lethal combination of heroin and alcohol.

River Phoenix

The actor died at age 23 on Oct. 31, 1993, after collapsing outside a Hollywood nightclub. Tests showed high concentrations of heroin and cocaine in his blood.

Hillel Slovak

The founding member of the band Red Hot Chili Peppers died at age 26 on June 25, 1988, of a heroin overdose in his Hollywood apartment.

John Belushi

The comedian died at age 33 on March 5, 1982, after an injection of cocaine and heroin in his Hollywood hotel room.

Sid Vicious

The Sex Pistols bassist died at age 21 on Feb. 2, 1979, from a heroin overdose at his girlfriend's house in Greenwich Village.

Jim Morrison

The frontman for The Doors was found dead in a Paris apartment bathtub at age 27 on July 3, 1971. Although no autopsy was performed, it's believed he overdosed on heroin that he thought was cocaine.

Janis Joplin

The singer died at age 27 on Oct. 4, 1970, in a Hollywood hotel from a heroin overdose, possibly compounded by alcohol. She died just 16 days after Jimi Hendrix overdosed on sleeping pills.

He was wrong.

By the numbers

13

Number of South Carolinians who died from a heroin overdose in 2012.

4.2 million

Number of Americans ages 12 or older who have used heroin at least once in their lives.

23

Percentage of people who become dependent on heroin after trying it.

23

Average age an American tried heroin for the first time in 2012.

178,000

Number of new heroin users nationally in 2011.

3,036

Number of Americans who died from heroin overdoses in 2010.

Sources: U.S. Drug Enforcement Administration, National Institute on Drug Abuse, S.C. Department of Health and Environmental Control

"When you inject it for the first time, you get this feeling of euphoria and you don't have a care in the world.

Heroin is an opioid drug that is synthesized from morphine, a naturally occurring substance extracted from the seed pod of the Asian opium poppy plant.

It can be injected, inhaled by snorting or sniffing, or smoked. All three methods deliver the drug to the brain rapidly, which contributes to its health risks and to its high risk for addiction.

Source: National Institute on Drug Abuse

You could be sitting in a room and it's on fire, and you just have this wonderful, relaxed feeling about it," the Charleston man said. "But its hard to get that feeling again, and you keep chasing it, doing more and more until the next thing you know, you're hooked."

Mike, who spoke to The Post and Courier on the condition that his last name not be used, said his addiction drove him to rob people and break into homes to get money to support his three-bag-a-day habit.

The pull of the drug was so strong that when he left prison after one five-year hitch, all he could think of was scoring some heroin again.

"Never try it," said Mike, a tradesman who has now been clean of heroin and pills for three years. "The first time you try it, you'll fall in love and become a junkie for the rest of your life."

Despite such dire warnings and an abundance of cautionary tales - most recently, the death of Oscar-winning actor Philip Seymour Hoffman from an apparent overdose - heroin use is on the rise across the nation. Anecdotal evidence suggests that is the case in the Charleston area as well, though no firm statistics could be found last week.

Heroin is no longer the domain of gaunt junkies shooting up with dirty needles in bombed-out inner-city buildings. It's turning up in high schools, colleges and suburban neighborhoods.

"We see it across the spectrum," said Keith Borg, an emergency room physician at Medical University Hospital. "I've actually seen it in the pediatric emergency department - not commonly, but I certainly have."

It's far from an epidemic, Borg and others said. MUSC doctors, for example, still see far fewer heroin addicts than patients with alcohol or cocaine addictions. State health statistics also show deaths from alcohol and cocaine poisoning dwarf those caused by heroin.

Even so, policymakers are concerned about heroin's growing popularity across the country. The number of recorded heroin deaths nearly doubled nationally between 2000 and 2012, and the National Survey on Drug Use and Health reported a noticeable jump in new, and younger, users in recent years. Between 2007 and 2012, the number of people reporting heroin use in the previous year increased from 373,000 to 669,000 - a nearly 80 percent jump, the survey found.

In his annual State of the State address last month, Vermont Gov. Peter Shumlin devoted nearly his entire speech to what he called "a full-blown heroin crisis," and he called on lawmakers to pass legislation encouraging treatment.

"We're seeing greater seizures of heroin on our borders with Mexico," Gil Kerlikowske, director of the Office of National Drug Control Policy, told The Post and Courier during a visit to Charleston last year. "And we're seeing a group of young people that are pretty na´ve about the dangers of heroin."

Cheap and abundant

Police and drug experts said tougher laws on prescription medications have made opiate pills such as Oxycodone harder for addicts to get. That, combined with the cheaper price and greater abundance of potent heroin, has led to more people turning to the dangerous drug to get high, they said.

"For a period of time, we were seeing more prescription drug issues," said Jonas Coatsworth, program administrator for the opioid treatment program at Charleston Center, a county-run prevention, education and treatment facility. "But recently, for the past several months, we have been seeing an increase in admissions for heroin as the drug of choice."

It's easy to see why. A single 30-milligram pain pill such as Oxycodone can sell for $1 per milligram on the street, while 10 to 13 bags of powdered heroin can be had for $100. The Charleston area's proximity to Interstate 95, a key drug-smuggling corridor between Florida and New York, generally has translated into an accessible supply of heroin in the area for years, Coatsworth and police said.

"It really is a big problem in Charleston," said Assistant U.S. Attorney Sean Kittrell, who works with the Violent Crime Task Force. "It's a prevalent drug being sold here, and there sure are a lot of customers for it."

Comparatively, area police encounter fewer heroin cases than those involving other drugs. The Charleston County Sheriff's Office, for instance, handled 25 heroin cases between January 2010 and December 2013, compared to 417 marijuana cases and 210 cocaine cases during the same time period, according to Maj. Eric Watson.

Still, as with drugs like crack cocaine, the heroin trade remains a lingering and entrenched presence in the area, despite concentrated law enforcement efforts to disrupt and uproot it.

Cracking down

Among those efforts were 2001's "Operation Mayday," which targeted heroin dealers on Charleston's East Side and resulted in nearly 40 convictions, and 2002's " Operation Broken Needle," aimed at 32 suspected heroin dealers in the same neighborhood.

Another 19 people were rounded up on heroin and crack cocaine charges in a 2008 operation that targeted drug dealers in the Ardmore, Maryville/Ashleyville and East Side neighborhoods.

A year after that, North Charleston police, working with the U.S. Drug Enforcement Administration, busted another supplier bringing 14 ounces of heroin into the area from New Jersey in a secret, mechanized compartment in his car.

Then, federal, state and local investigators shut down a major heroin ring operating out of Charleston's Bridgeview Village Apartments following the 2010 murder of a key dealer. They indicted 27 people, including a supplier caught in 2011 moving 10,000 bags of heroin, worth about $200,000 if sold on the street, from New York to Charleston.

Even with that success, Charleston police arrested another 79 people in the last two years on heroin charges, police records show.

Lt. Sterling Dutton, Charleston police narcotics unit supervisor, said the busts have affected the drug trade, and area police agencies work closely together to keep the pressure on the dealers. "We do have a problem. It's out there," he said. "But we're working real hard on it, and we're still making cases and going after the dealers."

Kittrell said the problem is that the heroin trade is lucrative for some, and the area is well situated for suppliers to bring in shipments from places like New York City, as Bridgeview's so-called "B-Mob" did with branded heroin bundles obtained from Dominican traffickers in New York.

"(Crackdowns) affect the market because they shut down the distribution chain, but because of the money involved it comes back," he said. "The heroin trade has blossomed over the years, and it seems as if many of the criminal street gangs are dealing with heroin primarily because they can quickly make a good profit from it."

National problem

Charleston is hardly the only community struggling with a heroin problem.

Just last month, the DEA shut down an alleged heroin mill operating out of the Bronx in New York, seizing $8 million worth of the drug. And in Pittsburgh, police busted a McDonald's worker accused of selling heroin in Happy Meals, according to multiple reports.

Nationally, heroin deaths nearly doubled from 1,842 in 2000 to 3,036 in 2010, according to the latest totals from the Centers for Disease Control and Prevention.

In the Minneapolis-St. Paul metro area alone, heroin overdose deaths nearly tripled from 2010 to 2011, increasing from 16 to 46, according to the DEA's 2013 National Drug Threat Assessment.

Area coroners said they have not seen dramatic spikes in the number of heroin deaths locally, and death statistics provided by the state health department bear out this anecdotal evidence. Thirteen South Carolinians died from a heroin overdose in 2012, compared with 27 who died from an alcohol overdose and 49 who died from a cocaine overdose.

Medical University Hospital's emergency room also hasn't seen a dramatic jump in heroin overdoses. "We see problems and complications from alcohol every single day in the emergency department," Borg said. "We see a few cases of heroin a year."

But national statistics suggest there still is cause for concern.

The National Survey on Drug Use and Health reported a sizable jump in the number of new heroin users across the country in recent years, along with indications that these new users are younger than they were just a few years before. The average age for first-time use of heroin was 22 in 2011 and 23 in 2012, compared to around 26 years old in 2009.

What's more, a 2011 study found that about 4.2 million Americans ages 12 or older had used heroin at least once in their lives, and an estimated 23 percent of users become dependent on it, according to the National Institute on Drug Abuse.

"Heroin has this sort of dark allure to it that's part of its mystique," said Eric Schneider, a professor at the University of Pennsylvania who wrote the book "Smack: Heroin in the City," a historical account of the drug. "What I've heard from heroin users is that flirting with addiction is part of the allure, to sort of see how close to that edge you can get and still pull back."

At the same time more folks are experimenting with the drug, heroin availability has continued to increase in the United States, likely due to an increase in Mexican production of the drug and Mexican traffickers expanding into the eastern and Midwest markets, according to the DEA. The amount of heroin seized at the country's southwest border jumped 232 percent between 2008 and 2012, the DEA said.

Perhaps the most striking trend about heroin's most recent incarnation is that a drug that was once largely confined to major cities is spreading into suburban and rural towns across America, where it is used predominantly by adults between the ages of 18 and 29, said Jim Hall, an epidemiologist who studies substance abuse at Nova Southeastern University in Fort Lauderdale, Fla.

"We haven't really seen something this rapid since probably the spread of cocaine and crack in the mid-1980s," Hall said.

Coatsworth, of Charleston Center, said his treatment center also is seeing more young people for heroin use, and "we're seeing younger people with a history of intravenous use."

The drug's reach and lethality was demonstrated locally in 2007 when 18-year-old Evan Hardison died from an overdose after trying heroin for the first time at a Mount Pleasant party. The dealer who sold that fatal batch later got 27 years in prison.

"He was the last person you would ever think would be a heroin user or would ever even experiment with it," said Brian Hardison, Evan's father. "He had everything going for him. But all it takes is one time with a drug that potent. It's not like a prescription pill where you know exactly what's in it, who made it and where it came from."

Heroin is a notoriously difficult drug to kick, with potentially severe withdrawal symptoms. But a variety of effective treatments are available for heroin addiction, including methadone, a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms.

The problem, Coatsworth said, is that Medicaid in South Carolina and many insurance providers don't cover the cost of methadone maintenance programs. "It can be a steep bill to pay," he said, "and it's all out of pocket."