The number of first-time heroin users in the U.S. is on the rise, and overall, heroin use went up 66 percent in 2011. And it's reached epidemic proportions not in big cities so much as in rural towns and suburbs of America.
In the emergency room at the University of Alabama at Birmingham Hospital, you'd of course see stab wounds, heart attacks, and every now and then, a heroin overdose. That was about two years ago. Now?
"I can tell you that there is not a day that goes by in this emergency department that we are not dealing with someone who actively is using heroin, or someone who has presented to us for help in getting off of their heroin," says Janyce Sanford, chair of emergency medicine there.
She says a few years ago, the drug overdoses she saw were usually cocaine. "We still see a fair amount of cocaine there, but the heroin population has just exploded."
"When we were not seeing much of it around here, we kind of considered it a drug that was used up north in the larger cities -- Chicago, New York, Detroit, out west in L.A.," says Lt. James Davis. He heads up the narcotics unit at the Jefferson County Sheriff's Office, Alabama's densest area. He says at most, they used to make two or three heroin arrests a year.
"Over the past year, we averaged somewhere between two and six heroin trafficking arrests per month," Davis says.
He says it's everywhere -- quiet rural towns, affluent neighborhoods. In nearby Shelby County, even the pastor of a small country church was arrested in July for heroin possession.
That's no surprise to Dan Duncan, associate executive director of the National Council on Alcoholism and Drug Abuse in St. Louis. "Middle, upper middle class sometimes, young person -- late teens, early 20s, living in suburban areas, and now we're seeing rural areas."
Duncan says that's because the drug is cheaper now. "They make what they call a button, which is just a capsule of heroin, for about $10."
That's compared to up to $75 for a prescription pain pill. And pain pills are where a lot of heroin addictions begin. Police say the same people selling pain pills on the street are switching their customers over to heroin.
A study released this month by the Substance Abuse and Mental Health Services Administration says that people who used pain pills non-medically were 19 times more likely to start using heroin.
And there's another draw for new heroin users: This new form can be snorted.
"One of barriers historically to drug users even trying something like heroin was the needle," says Duncan.
In St. Louis, Duncan's agency launched a campaign in 2011 to curb the heroin epidemic. It put ads on buses and in movie theaters. The group teamed up with police. And now that school is starting, they're planning more town hall forums. Duncan says it's finally working. Last year in St. Louis, he says, the number of heroin overdose deaths fell by 25 percent.