Heroin Heroin
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Chico Lewis heaves open the sliding door of the van. 

It’s 9 a.m. A middle-aged man waits patiently on the driveway outside West 25th Street’s Hispanic Urban Minority Alcoholism Drug Abuse Outreach Project. It’s next door to South Pointe Commons, an 82-unit public housing facility for the disabled and homeless. 

In a black shirt and camouflage shorts, the man clutches a brown paper bag. “How many you have?” Lewis asks, pointing to the bag.

The man leans over a container beside the van’s door. He pours in 20 used syringes. “Twenty-two, please?” the man asks, raising his arms and resting his hands on his shaved head.

Lewis shakes his head. He points to a sign on the van wall: Until further notice ONE 4 ONE.

“We can only give you 20,” says Lewis.

The man shrugs. Lewis grabs two packs of clean 28-gauge syringes, a handful of alcohol wipes and a small tin can for cooking — a toolkit for using heroin.

“Be safe,” Lewis says, handing him the supplies.

“I mean, you know,” says the man. 

He tugs his shirt forward so Lewis can read the white letters splashed across his chest: I’m not dead yet!

“That’s what everybody’s wearing now, huh?” Lewis says, laughing half-heartedly. He nudges his partner, Roger Lowe, who sits in the front of the van with his eyes on the street. The pair have been sober for more than 20 years. They understand the struggle.

“It’s sad, but heroin addicts,” Lowe pauses a few seconds, “or people who suffer from my disease, we’re like vampires — constantly focused on our next fix, our next meal.”

Chico Lewis With His Needle Exchange Van

Lewis has operated the Cleveland syringe exchange program through Circle Health Services since 1997, two years after it launched. Last year, the free clinic’s exchange provided 495,000 needles to 4,000 people in an effort to dissuade the sharing of needles, which can spread diseases such as HIV. It’s a stopgap against an epidemic.

Three years ago, Cleveland Magazine shared the stories of 194 people who overdosed from heroin in Cuyahoga County in 2013. We didn’t know it then, but that was just the first crash in a series of terrible waves. Last year, 1,095 people died in opioid-involved deaths in Cuyahoga, Geauga, Lake, Lorain, Medina, Portage and Summit counties. 

Opioid Related Deaths in NE Ohio (2016)It’s made us grim experts in death. In testimony before a senate subcommittee, Cuyahoga County medical examiner Thomas Gilson compared the opioid crisis to a natural disaster and called it a “nationwide public health emergency.” 

In Cuyahoga County, there are enough people dependent on opioids — including prescription painkillers and heroin — to fill the 67,895-seat FirstEnergy Stadium, Gilson estimated. 

The problem is one that’s been made increasingly dangerous by more lethal opioids on the streets — fentanyl, a tranquilizer 80 times more powerful than heroin, and carfentanil, a tranquilizer powerful enough to put down a 12,000-pound elephant and kill a human on contact.

“What else would you call this but a mass fatality event?” asks Gilson.

Throughout Northeast Ohio public agencies are expanding treatment, elected officials are pushing for more funding, police are stepping up enforcement and first responders are increasingly being called to revive overdose victims. But they are barely making a dent. 

Like a virus, the epidemic is evolving, staying several steps ahead of its pursuers. 

“Any responsible public official that looks at what’s going on would say we have a health crisis here,” says Cuyahoga County executive Armond Budish. “We’ve got people dying every day.”

For Lewis and Lowe, working on the frontlines of the epidemic means they’re confronted with death daily.

“They don’t know what they’re getting into,” says Lewis.

And yet, like farmers market customers browsing for heirloom tomatoes, more than 30 people walk up to the van over the next four hours.

A woman in her 50s arrives with seven needles hidden in a red pack of Maverick 100s. Another woman in her 30s, wearing a pink crop top, carries 200 needles in a Walmart shopping bag. 

A young man in a gray T-shirt appears outside the van with an open abscess on his left forearm. The on-staff nurse asks if he wants treatment.

“Naw,” the man says, pointing to the puss-filled wound. “This is a shot about 15 minutes ago.” He walks away with 20 needles.

Behind him, a construction worker in his 20s holds a blue kit from MetroHealth System’s Project Dawn. The program distributed 2,360 free kits of lifesaving naloxone, also known by the brand name Narcan, in Cuyahoga County last year. 

Project Dawn and Circle Health Services

A spray in the nose can bring an overdose victim back from the brink. First responders say it raises the dead — blue from suffocation one moment, alive and talking the next. 

He opens the Project Dawn bag. Inside are 30 needles. He leaves with 20 fresh ones, the maximum allotment.

The next customer arrives on a small green bicycle. He’s like most, a regular who comes through at least once a week. He reminisces with Lewis about a mutual acquaintance, an older guy who overdosed in the neighborhood. 

“That effed me up,” says the guy. “Ninety percent of the heroin out here has fentanyl in it. You’re not going to find just heroin. You’re not. It’s garbage.”

The nurse cuts in. “So when are you going to get clean?”

He shakes his head and wipes his nose. “One day,” he says.

“Just watch those doses,” says the nurse.

She warns him about the newest rumor: If you cook up the powder and it turns into a clear red liquid, like Jell-O, it’s really strong. He should avoid it, run like hell the other way.

“I haven’t bumped into that yet,” he says, perking up on his bike. “I’ll go ask for that by name.”

“Why?” shouts the nurse. “I just told you that people have almost OD’d on it.”

He laughs.

“You want me to tell you what the addict does?” he asks, leaning forward on the handlebars. “Let me tell you how the addict’s mind works.”

He looks out to the street, holds his breath, looks back.

“I won’t do as much,” he says. “That other guy? The guy who died? That guy was greedy. He did too much. I won’t be a fool like him.”

 

It began with pills.

In 2012 and 2013, the U.S. Attorney’s Office for the Northern District of Ohio convened summits to tackle the flow of prescriptions painkillers and heroin into the region. They began working with Cleveland Clinic, University Hospitals, MetroHealth System, county, city and federal law enforcement, prosecutors, treatment organizations and people recovering from addiction to come up with a plan to cut down on overprescribing. 

A Drug Enforcement Administration unit specializing in prescription enforcement shut down pill mills — unscrupulous clinics or doctors who prescribed dose after dose of painkillers, not for legitimate medical use, but to feed patients’ habits. The Northern District office began dispatching speakers to train doctors and nurses on the dangers of opioids and the warning signs of individuals misusing prescriptions. 

Their efforts, and similar ones in state government, got results. Between 2012 and 2016, the number of opioid doses prescribed in Ohio dropped by 23 percent. According to the Centers for Disease Control and Prevention, the number of opioid prescriptions dispensed per 100 people in Cuyahoga County fell from about 70 in 2014 to 61 in 2016.

The idea: treat the earliest symptoms of the epidemic before it can spread.

Heroin-related Overdoses and Prescriptions“We didn’t do enough, I think, at that time, on the treatment end,” says assistant U.S. Attorney Joseph Pinjuh, head of the Cleveland office’s drug unit. “We were shrinking the supply, and we still had a big demand out there. You saw the rise of heroin.”

It was no longer a problem contained to heavily populated cities such as Cleveland and Akron. In 2014, 198 people died from heroin-related overdoses in Cuyahoga County — half of them in the suburbs. 

“There’s more heroin around than any other drug,” a survey taker told the Ohio Substance Abuse Monitoring Network in a January 2014 report. 

It started trickling into surrounding counties. The Lorain Police Department saw it early and became the first in the state in 2013 to equip its officers with Narcan. Within 24 hours of its rollout, officers had used their first dose to revive a 21-year-old woman. 

But just as the U.S. Attorney’s office and similar task forces in Cuyahoga, Lake and Summit counties began grappling with the heroin problem in 2014, fentanyl started cropping up in reports from Gilson’s office.

It was the early warning sign of a terrifying new trend. Fentanyl was being mixed with heroin or a mixture of other drugs. 

Gilson’s office began notifying law enforcement throughout Northeast Ohio about the new problem.

The Fentanyl Effect

“When you start to see fentanyl show up in a community, you start to see mortality take off dramatically,” says Gilson. “We were absolutely worried that was going to happen — and in fact, that is what has happened.” 

Dealers know the danger of what they’re selling. In September 2016, two brothers and reputed members of the Latin Kings gang, Mizraim and Abimelec Vega, were indicted for conspiring to sell heroin and fentanyl, 80 grams or $8,000 worth, to an informant wearing a wire. 

“The one thing I’ll tell you is to make sure to cut it. That stuff … you can’t send it out to the street like that, it’s too strong,” Mizraim told the informant during a meeting outside a Bosworth Avenue apartment building on Cleveland’s West Side, according to court documents. “That stuff could kill someone, bro!”

Travis Bornstein has a sales pitch. On the edge of his chair in a Panera Bread in Akron, he rapidly recites a list of his 23-year-old son Tyler’s impressive accomplishments: golf in middle school, two holes-in-one by his 16th birthday, all-league his freshman, sophomore and junior years, an ironman award for varsity football his senior year at Lake High School, graduating magna cum laude from Lake High’s legal studies program and promising career prospects from Walsh University’s accounting and finance program.

“He was a talented kid — smart, athletic, good looking,” says Bornstein, tapping an index finger into the palm of his hand with each beat before pausing for dramatic effect.

“So how does a kid like that get addicted to heroin?” he asks.

Tyler broke his arm four times. He had two surgeries on his right elbow. Doctors prescribed him painkillers. 

“We believe somewhere during his senior year of high school, he started abusing opiate pain pills,” says Bornstein.

In 2010, Tyler confessed to his parents. He was hooked on heroin. Over the next three years, Tyler was in and out of rehab. 

“But he could never get a year under the belt,” says Bornstein.

In 2013, when Tyler graduated from a 21-day treatment program at the Glenbeigh Center of Beachwood, his parents took him to a sober living facility in Florida. After six months, Tyler returned to Akron and moved into an apartment with his girlfriend and her family.

In September 2014, Tyler relapsed yet again. Sobriety wasn’t working. He had used up the two-time lifetime inpatient treatment policy on his health insurance. 

The family coffers were drained. 

In a last-ditch effort, Tyler got onto Summit County’s waiting list for a publicly funded treatment program. But, his parents say, the list was so long it would take three weeks to even get into detox. So to cut himself off, he asked his parents to take his car.

It wasn’t enough. On Sept. 28, 2014, Summit County sheriff’s deputies arrived at the Bornsteins’ home in Uniontown. 

Tyler’s body had been found in an overgrown lot just 3 miles north of where they now sit in the Panera Bread. He was wearing gray shorts and a blue sweatshirt. Between his legs was a syringe.

A subsequent investigation revealed that Tyler met with an acquaintance the day before at a nearby Akron gas station. The two bought heroin from a 19-year-old dealer. When Tyler overdosed in the passenger seat, the driver panicked. He left Tyler alone in the vacant lot, according to police. A Summit County medical examiner’s report showed Tyler had overdosed on fentanyl.

“As parents, we’re all dealing with guilt,” says Bornstein. He slows down now, sitting back in the chair and muses over questions he’s mulled in his head in the wake of his son’s death: What did I do wrong as a parent? What did I do to cause my son to use drugs?

“But if you understand it as a disease, flip it,” says Bornstein. What did I do to cause you to have leukemia? Or heart disease? Or diabetes?

“It’s not my fault,” Bornstein says. “The real question becomes, ‘When tragedy strikes you, who are you? And what do you do?’ ”

According to Keith Martin, assistant special agent in charge of the DEA’s Cleveland office, this is Sinaloa cartel territory — the drug trafficking organization formerly headed by Joaquin “El Chapo” Guzman. 

Primarily grown and processed in Mexico and Colombia, Martin says, heroin arrives packaged separately from fentanyl. Local dealers cut them together, along with other substances such as laxative or baby powder, and package it for sale on the street. Dealers also acquire fentanyl online from overseas suppliers, mostly Chinese, and ship via the U.S. Postal Service. As distribution is increasingly decentralized, the stuff seems to be everywhere and come out of nowhere.

In the last year alone, the DEA had record seizures of cocaine in Cleveland and meth in Central Ohio, says Martin. “On top of that,” he says, “we’re seeing kilogram quantities of heroin, kilogram quantities of fentanyl.” 

In September 2016, DEA agents got a tip that two Mexican nationals had parked a semitrailer near a warehouse in Collinwood, just around the corner from Hannah Gibbons-Nottingham Elementary School. 

Agents seized 92 bricks, or roughly 200 pounds, of cocaine, a drug increasingly cut with fentanyl. 

Last October, Martin’s agents also worked on a case that resulted in indictments for 20 people. They seized 29 kilograms of cocaine, 8 kilograms of heroin, about $400,000 in cash, firearms and 1 kilogram of fentanyl. 

“That kilogram of fentanyl could have killed hundreds of people,” says Martin. “So I’m proud of that.”

Keith Martin

Last year, 399 of the 666 drug overdose deaths in Cuyahoga County involved fentanyl. “We are probably going to see things get worse before they get better,” says Gilson.

It already has. The medical examiner’s office has had to bring in mobile refrigeration units to keep up with the body count. Hospitals are being inundated with overdoses. 

100 Days of Double Digit Drug OverdosesIn Summit County last year, there were 100 days from June to December in which overdose admissions crept into double digits. It’s forced public health officials to use bioterrorism data tracking systems such as EpiCenter to keep up with the spread of disease and get ahead of the problem.

“As an ER doctor, my first thought was, Stop the bleeding,” says Dr. Joan Papp, medical director of MetroHealth’s Office of Opioid Safety, which includes Project Dawn.

In 2012, Papp helped push the Ohio Department of Health to get Narcan out of the hospitals and into the hands of the sick and dying. But even she says that was just the beginning.

“There’s nothing more frustrating than offering somebody a Band-Aid when what they need is major surgery,” she says. “There just isn’t enough treatment.”


According to statistics compiled by Cleveland Magazine for our seven-county coverage area, 17,953 people received publicly funded drug treatment in 2016. Put those people in FirstEnergy Stadium, and it’s only a quarter full. 

That’s a small fraction of those with addiction who are getting the help they need from city, county, state and federal leaders.

“We’ve spent a lot of time lobbying our state and federal government [for treatment money] and didn’t get very far with that,” says Budish. “So we got frustrated and decided we need to do something.”

The Alcohol, Drug Addiction and Mental Health Services Board of Cuyahoga County spends about $21 million on drug treatment, prevention and recovery each year. 

Over the past four years, the ADAMHS Board increased its spending by $4 million in response to the opioid crisis. In January, Cuyahoga County, the city of Cleveland and the ADAMHS Board allocated an additional $1.5 million to add 113 publicly funded treatment beds, bringing the total number of treatment and detox beds in the county to 444.

A Cuyahoga County public awareness campaign, Know the Risks, is also seeking to educate the public about the addiction risk of prescription painkillers, and raise awareness about drop boxes throughout the county for people to dispose of unused pills. 

Pushes to increase access to treatment are also underway. In Lakewood, the county is testing a pilot program making Fire Station No. 1 a 24/7 safe station for anyone seeking treatment services. Those who have struggled with addiction in the past will work on quick-response teams to meet with individuals who recently overdosed. 

Similar changes to help those with addiction find treatment are also happening in Lake and Summit counties. Since last summer, the County of Summit Alcohol, Drug Addiction and Mental Health Services Board invested $3.2 million for additional services that include 10 new detox beds and 28 new residential treatment beds within the county. 

“This is like a plane crash that’s gone on for years,” says Gerald Craig, executive director of the Summit ADM Board. “We could never have predicted that we would have this huge demand for services.”

For months after Tyler’s death, Shelly Bornstein returned to the lot where his body was found. 

“It was the last place my son took his breath,” she says. “So I wanted to see it.”

At first, she went alone. She picked berries and took rocks from the property back home to Uniontown. After a while, she started bringing friends, praying and finding solace over the spot where her son died, the shock of tall grass and knotted trees. 

Later on, she convinced her husband to join her at the lot. Slowly, their grief transformed into drive. 

This place, they decided, didn’t need to be full of darkness and pain. It could be a place of hope, where others like Tyler, people struggling with the disease of addiction, could find the help their son had so desperately needed.

Filled with new resolve, Travis Bornstein honed his pitch. 

On June 29, 2016, Bornstein, the president of Teamsters Local 24, worked up the courage to tell his son’s story onstage at the Teamsters’ 29th International Convention in Las Vegas. The response was overwhelming. 

By the end of the night, they raised $1.4 million for their vision. They purchased the lot where their son’s body was found.

“Our story is about the opioid epidemic and heroin, and fentanyl, but it’s also about forgiveness and hope,” says Bornstein. “We’re trying to offer hope back to the community and to some who think this is a hopeless cause.”

When the Bornsteins return to the 1 1/2-acre lot at Alfred Road and South Arlington Street, they explain a vision that has far outgrown their original idea. 

They’re working with Summit County, local health care providers and civic leaders to potentially acquire and develop a plot near the southern edge of the county. It will house a sober living community on a 20-acre campus. 

Initial plans for the all-in-one facility include residential treatment, medically assisted programs and support groups for families facing addiction. They also have hopes to add an on-site detox center — an approach not seen anywhere else in Northeast Ohio. It will also have a community center called Tyler’s Redemption Place.

“Redemption was a word I held onto for a long time,” she says, walking carefully through the lot beside her husband who wears a green shirt with the words Believe in Heroes.

“I am more comfortable here than at the gravesite,” he says. “This lot symbolizes the beginning of hope.”

They want to turn it into a memorial garden where people can come to mourn those who have fallen ill to the opioid epidemic that continues to ravish Northeast Ohio.

“We see the death and the destruction and what it’s doing to families and tearing up our communities,” Bornstein says. “Maybe we can get off of that road and get on another road of hope — a road of restoration, and healing and redemption — and bring our community back.”

He smiles.

“This ain’t the end of the story,” he says.

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