They peer from photos on abandoned Facebook and Instagram pages. They hug their loved ones, their children, their pets.
They pose for selfies. Smiling, they look like their whole lives lie ahead of them.
They certainly don’t look like junkies.
But these seemingly happy people are ghosts, victims of a growing epidemic of heroin-related deaths sweeping the nation.
Last year, 216 people died overdosing from heroin, fentanyl or illicit morphine in Palm Beach County. That’s more than died in car crashes and twice the number of homicides, a Palm Beach Post analysis of medical examiner records found.
Three-fourths were younger than 40, cutting short lives long before they could hit bottom — a critical step for many addicts to get clean in 12-step programs.
They are found in homes, motels and gas stations. They die in sober homes where they go to stay clean. They die in cars, backyards and residential streets.
They often are found kneeling, frozen with heads resting against floors, toilets, bathtubs.
Many times loved ones or roommates see them fast asleep on a couch or bed, snoring loudly. A few hours later, they check back and find them without a pulse.
And their deaths are sudden. Kevin Alvarez of suburban Boynton Beach went up to the attic, where he spoke to his wife at 11:30 p.m. When she checked on him 45 minutes later, he was dead, a tourniquet on his arm and a needle at his side.
“Everyone is at a loss for words. No one knows what to do. All my friends are saying, ‘Everyone is dying,’” said Josh Gamaitoni, a 26-year-old Delaware transplant who is 5½ years clean.
“Our generation has had more people die. If you look at it, this is like going to war. We are at war right now. There is like five RIPs a week on Facebook from my friends across the country. Everybody knows someone who has died.”
Money and drugs
Why are they dying?
- Fentanyl: Fifty times more powerful than heroin, fentanyl is mixed in with heroin to give the addict a more powerful high, but it can turn a familiar dose into instant death. More than 40 percent of the Palm Beach County deaths involved fentanyl.
- Purity: Heroin today is generally more pure and costs less than decades ago. The increase in purity makes the drug so strong that it can have the same effect on the brain by inhaling it, making it much easier to use.
- Lethal cocktails: Addicts are mixing heroin with cocaine, Xanax and a host of designer and prescription drugs. The Post found nearly half of those who died of overdoses in 2015 had at least five drugs in their system.
- The hot shot: Many addicts overdose after a stint in detox or a recovery program after their tolerance has dropped. A return to the familiar dose is often deadly.
But if there is just one cause of this unprecedented wave of overdose deaths, the word is money — cold hard cash.
Traffickers and dealers cut heroin with deadly fentanyl to increase potency and profit. A kilo of fentanyl costs between $1,000 and $2,000, compared with $40,000 to $60,000 for the same amount of heroin, said John McKenna, assistant special agent in charge of the Drug Enforcement Administration in West Palm Beach.
And fentanyl, prescribed in hospitals, often in patch form for severe pain such as gunshot wounds, can be bought on the Internet and often is found in Mexican heroin. Chinese manufacturers make slight alterations in the drug’s man-made chemical makeup to get around bans.
Florida’s economy benefits from these addicts. Many come here to get clean, attracted by the sun and a recovery community that generates about $1 billion annually in Palm Beach County. Exploitative players in the industry attracted to fast insurance money don’t educate addicts about the dangers of relapse. As a result, addicts are caught in a revolving door, putting them back on the streets before they’re ready.
“The treatment industry is so much based on a business model instead of a helping model, it’s insane,” said Justin Kunzelman, a recovering addict and the director of business development at Ebb Tide Treatment Centers in North Palm Beach.
And fueling it all is a pharmaceutical industry that makes more than $8 billion annually off prescription painkillers, led by the king of them all, OxyContin. Many young heroin addicts started with their hands in the cookie jar of their grandparents’ pain prescriptions and graduated to something more sinister.
But to those on the front lines — police officers and medics, researchers, recovery centers — the immediate culprit is fentanyl and other bathtub painkillers brewed up by traffickers and dealers.
A whole new market of synthetic opioids has taken root, producing drugs so strong that police and medics are warned to avoid touching them, said Dr. Bruce Goldberger, director of the University of Florida’s Health Forensic Medicine.
“We are riding a wave right now and who knows where we are going?” he said. “We still have large numbers of people dying from prescription drug overdoses and now we have many people dying from heroin, illicit fentanyl and other synthetic opioids.”
And while heroin’s potency is stronger than ever, an addict never knows what he is getting when it is mixed with fentanyl.
“You might think you are injecting heroin, the dealer might think you are injecting heroin, but you are being fed a hybrid of heroin or fentanyl or something like an elephant tranquilizer,” said David Ray, chief executive of Immersion Recovery Center in Boynton Beach.
Fentanyl will take out even an experienced drug user.
Stephanie Bergman, 43, mothered three sons and worked in the medical billing field. She also battled addiction to opiates for 15 years.
She was found in a bedroom of her parents’ home in a West Palm Beach gated community. Her blood showed a deadly mixture of heroin and fentanyl. In the drawer of a dresser next to her body, police found a copy of the “Narcotics Anonymous” guide to sobriety through a 12-step program.
Gamaitoni, who works for Transformations in Delray Beach, once had a $1,000-a-day prescription pill addiction. He considers himself fortunate to not be using in today’s environment, doubting he would survive in the age of fentanyl.
In September, he attended a funeral out of state for a friend who overdosed. When he returned, he got the news that one of his best friends sniffed “half a cap and fell out on Military Trail,” referring to the man’s near-death from snorting heroin from a capsule.
Paramedics revived Gamaitoni’s buddy with four doses of Narcan, the medicine that can bring an overdose victim back from death’s door. He suspects the overdose was caused by a type of fentanyl known as carfentanil, the elephant tranquilizer now being mixed with heroin.
Despite seeing friends and roommates die, some addicts still seek fentanyl for a better, more powerful high — a testament to the power of addiction.“The desire to get high overrides the rational thought process so much, and I know it sounds like a cliché, but you are playing Russian roulette,” Ray said.Gamaitoni said the soul-crushing physical pain of withdrawal is really what forces heroin users to put their life on the line.“So if you are out there and you are withdrawing, and you feel like you are dying and you know your boy just died from this one drug dealer and you can’t get anything from anyone else — you are going to that drug dealer because you have to feel better,” he said.
Heroin’s more pure, more deadly
The purity of heroin has increased from 10 percent in 1981 to more than 30 percent, DEA reports show. At the same time, the cost of a gram has fallen from more than $3,000 to about $500.
For the uninitiated, this new-and-improved heroin can be deadly, even without fentanyl.
Casey McRae, the young Texas mother of a 4-year-old girl, never took heroin before, her boyfriend told police, but tried it with him in Lake Worth. They snorted the drug, police reported. The medical examiner did not find fentanyl in her system.
Her father, Richard McRae, said his daughter wasn’t a drug addict and was a devoted mother. “The heavy drugs scared her,” he said.
Her funeral in her hometown of Wautaga, Texas, drew 300 people.
The modern addict
Derived from the poppy plant, heroin once was considered taboo even among those who indulged in illicit substances. Now, it is becoming more acceptable and accessible.
“Back home I’m hearing the kids are having parties now — 14-, 15-year-old kids — and they are busting out pills of heroin there. When I was that age, that was a shameful thing,” Gamaitoni said.
Younger addicts also have no compunction about mixing heroin with other hard-core drugs, such as cocaine, ecstasy, Xanax, even bath salts — often a deadly mix. Of the 216 heroin- and fentanyl-related overdoses here in 2015, more than 100 had five or more drugs in their system.
A recurring problem is immediate relapse after a stint in detox or a 30-day recovery program, when their tolerance has waned.
Ellen Witkowski, 20, of Wellington, left the Drug Abuse Foundation’s treatment facilities in Delray Beach on Dec. 29 and crashed on a friend’s couch. The next morning she was found propped up against the bathtub, not breathing.
Police found a syringe and an empty capsule with a brown residue in Witkowski’s makeup bag. Her autopsy revealed six drugs in her system.
Her father told police she was in court-ordered treatment and was not supposed to leave DAF.
“People are going back home after treatment and two days later they are passed away,” Gamaitoni said. “These are friends of friends, cousins. Some people never have been in treatment. … They never got the chance.”
‘Lazy and entitled’
Many in the recovery industry want to help addicts get clean, but they say it’s difficult getting through to millennials.
Not all of it can be laid at the feet of the recovery industry, Gamaitoni said. Getting through to millennial addicts is difficult. Getting clean takes work and many are not up to the task, which leads to relapse, overdose and death.
“Our generation is lazy and entitled and they don’t know how to work. They want everything given to them,” Gamaitoni said.
Julia Burd, 25, a recovering addict and manager at Sober City Recovery Center in Lake Park, said young addicts know they are a valuable commodity. “These kids have their insurance cards memorized,” Burd said.
Both Gamaitoni and Burd are millennials.
Burd got clean two years ago at Lucida Treatment Center in Lantana and for eight months she didn’t own a car, biking to work for a minimum-wage job. She watched as other young addicts were given cars by their parents and money to live on. And she watched those addicts relapse.
“It comes down to, you got to want it. I didn’t get two years clean floating in the wind,” said Burd.
All Gamaitoni knows is that something has to change. He is tired of burying friends and clients whose survivors include grandparents.
“The people who are sober have had so many friends die, we are numb,” he said. “We are like, ‘Say a quick prayer, maybe write something nice to the family and move on,’ and think, ‘Who is the next one?’ It’s a shame. I’m comfortable at funerals now.”
Reporter Joe Capozzi contributed to this story.