In response to a spike in York County heroin deaths this year, the county's coroner, district attorney's office and police are working together to find ways to combat the deadly increase.
"You're playing Russian roulette every time you're sticking a needle in your arm," District Attorney Tom Kearney said. "Heroin is flooding the market. ... From what I've been told, it's a statewide and nationwide problem. We have to react to what we're seeing, and we're trying to do that."
In 2013, the York County Coroner's Office recorded 16 confirmed heroin-related deaths, plus two more overdose deaths that were ruled "highly suspicious" for heroin, according to Coroner Pam Gay.
'Significant' increase: So far this year, Gay's office has recorded four confirmed fatal heroin overdoses and is waiting for toxicology reports on nine suspected heroin deaths, she said.
"You can see we're already at a significant rate above what we were last year," Gay said.
Because heroin breaks down in the body, sometimes all a blood test can confirm is the presence of a general opiate, rather than the specific type of opiate, the coroner said. In the "highly suspicious" cases, there was either heroin or related drug paraphernalia found at the scene, or the deceased had a history of heroin use, Gay said.
"We're going to start to get more aggressive" about investigating heroin deaths, the coroner said. "We're doing autopsies on all heroin deaths, both known and suspicious."
Going after dealers: The autopsies will be necessary for prosecutors if they decide to go after a dead heroin user's drug dealer, according to chief deputy prosecutor David Sunday, who said Pennsylvania has a first-degree felony charge called drug delivery resulting in death.
"To prove that charge, we have to prove beyond a reasonable doubt that the (victim) died of a heroin overdose," which is where the autopsies come in, he said, because the procedures would rule out any other possible causes of death. "We're in the infancy phase. ... We're still working out how we're going to go about doing this."
But Sunday said he doesn't expect the district attorney's office will be prosecuting a large number of such cases.
Hard to prove: "We all understand that it is extremely difficult to prove these cases," he said, primarily because drug deals are often secretive. "We're not expecting a flood of these cases."
Prosecutors won't be going after "the poor souls who are just selling a little bit of what they have to get the money for a fix," according to Sunday.
"The person who has made a decision to be a professional drug dealer — the person who makes money selling this poisonous product in our community — that's the person (being targeted)," he said.
Awareness campaign: The option of prosecuting heroin dealers whose customers die isn't the sole focus of what prosecutors, police and the coroner are discussing, Sunday said.
"This is just one component of what we hope will be a larger awareness campaign so the community understands how serious this problem is, in the hopes of stemming heroin overdose deaths," he said. "What we're talking about is in its infancy, and we don't expect to solve this problem overnight. ... We're trying to attack it from different angles."
Law enforcement will be closely watching to see whether York County's increase in fatal heroin overdoses is merely a statistical anomaly or a trend that will continue, he said.
Growing problem: According to the White House Office of National Drug Control Policy, the number of heroin overdose deaths nationwide has increased 45 percent from 2006 to 2010.
One reason for the rise appears to be the increase in popularity of abusing prescription opiates, such as OxyContin, Kearney said.
"I think without a doubt that's one factor that enters into the equation," he said, because OxyContin is more expensive and it's becoming more difficult for abusers to go from pharmacist to pharmacist and get enough of the drug.
Cheaper high: "Heroin is a cheaper alternative that will take away the pain and give you a high," Kearney said.
Addicts can buy a bag of heroin for $10, according to Gay.
The coroner said she suspects another reason for the increase has to do with victims' tolerance levels.
"In some of these deaths, people have been to rehab and gotten 'clean,'" Gay said. "As a result, their tolerance is pretty much gone."
So when former users relapse and try to inject or snort the same amount of heroin they had been using prior to rehab, they can more easily overdose, she said.
Also, users don't know the purity of the heroin they are using, so they don't know from bag to bag how high they will get, Gay said.
'Killer' heroin: Gay said so far, no one in York County has died of a type of "killer heroin" that's been laced with other substances, which state Attorney General Kathleen Kane has warned the public about.
She noted the middle class is hit just as hard by heroin addiction as people living in poorer neighborhoods.
"I know what addictions can do to families, and it can happen to anybody," Gay said.
— Reach Liz Evans Scolforo at firstname.lastname@example.org.