The heroin trail [The Citizens’ Voice, Wilkes-Barre, Pa.]

Sept. 29--At 13, he began drinking and smoking cigarettes.

That was the beginning of the end.

By the 10th grade, Erik Coolbaugh was in rehabilitation. He began keeping a journal detailing the drugs he took: marijuana, pills, opium, morphine, cocaine, ecstasy, heroin.

It says he started his own methamphetamine lab in 2004. "No family left. Chased them all away," he wrote in one entry.

"Three heart attacks," he wrote in 2005.

But it didn't stop him.

Coolbaugh died of an overdose Jan. 22, 2009, eight months shy of his 30th birthday. At the time, he was taking methadone for a heroin addiction.

He left behind three children.

"I know how hard he tried and I know what a hold that heroin is," his mother, Carol Coolbaugh, 62, of West Pittston, said. "There's only three ways out: You either go crazy, you go to jail or you die."

The year Erik Coolbaugh died, there were 16 heroin-related deaths -- those in which heroin caused or contributed to a fatality -- in Luzerne County, according to the county coroner's office.

That number surged to 33 in 2011, followed by 31 last year. As of last Wednesday, there were already 21 heroin-related deaths in the county in 2013, according to the coroner's office.

Heroin has besieged Northeastern Pennsylvania. The drug has been linked to homicides, shootings, robberies and thefts. Police say it is the biggest threat they see on the streets. They seize thousands of dollars worth of the drug at a time, but traffickers keep flooding the region with more.

Treatment facilities say it is the drug of choice for their patients -- people who often can't admit they need help until they hit rock bottom. One of the county's two methadone clinics has a two-week wait to get in.

It is a drug that makes addicts do and say just about anything to get. And no one knows how to stop it.

No greater threat

A poll of law enforcement agencies in 2011 ranked heroin as the No. 1 threat to the region, representing a reversal from just a few years earlier in 2008, when more police thought cocaine was the biggest threat.

The number of Drug Enforcement Administration arrests for heroin in Pennsylvania increased sharply, from 116 in 2007 to 185 in 2010, the report says, and the amount of heroin seized has skyrocketed.

In 2008, law enforcement seized 35.3 kilograms of heroin, according to the report, the Eastern Pennsylvania Drug and Gang Threat Assessment. In 2010, authorities seized 263.7 kilograms -- a 647 percent increase in just two years.

The DEA characterizes heroin as a "high-availability" drug with a more steady supply entering the region compared to a year ago, according to a DEA official who spoke on condition of anonymity because he is not authorized to speak to the media.

The heroin typically originates in South America and is trafficked to Philadelphia -- the regional hub of drug trafficking activity -- by Mexican organizations using vehicles, drug mules and commercial flights, the official said.

"Philadelphia has typically had the highest purity level east of the Mississippi," the official said. "So what happens is it gets into Philadelphia and the stuff then goes out to Scranton, Allentown, Harrisburg."

As the drugs have infiltrated the regional hubs, crime has been close to follow. Luzerne County District Attorney Stefanie Salavantis called heroin a driving factor behind many crimes in the county.

"You see a lot of this stuff happening because of the addiction," Salavantis said.

Police in Wilkes-Barre increased manpower to their Tactical Anti-Crime Unit after a series of robberies in the city earlier in the year. The unit has made numerous arrests on drug and weapons charges.

A theme common to most cases: heroin.

"Based on the number of felony arrests involving heroin, it appears to be the current drug of choice," city spokeswoman Liza Prokop said.

Kingston police detectives Rich Kotchik and Edward Palka arrested a couple Sept. 20 for possessing 171 packets of heroin worth more than $3,000.

"A lot more crime, I think, is generated by heroin addicts because it's such an addictive drug. It has such an addictive power to it that they don't care who they have to hurt to get it," Palka said. "You can't function without it. Your body needs it so badly and you can't work, so you have to resort to stealing."

The drugs now frequently come by bus, car or taxi from New York or Philadelphia, they said. But it didn't always happen that way.

In the 1990s, Kotchik said, suburban kids from the area would travel to Philadelphia to buy a brick -- 50 bags -- to feed their own habits and sell some to others at home."Then all of a sudden, boom. I think the inner city started saying, 'Wow all these guys are coming up here,'" Kotchik said. "Then all of a sudden you started seeing that transition coming."

Drug dealers in Philadelphia would charge more to customers they knew were bringing the dope home to sell. Then they decided to cut out the middlemen.

"The welfare system and the Section 8 system definitely plays a role in what's here," Kotchik said. "When everybody started coming up here, the heroin was still going for $20 a bag and they were making money. A lot of them were either moving in with somebody who was on assisted living or they were trying to get it themselves. And the next thing you know, families were coming up. Now, as the years went by the $20 a bag, the norm, started changing because of the competition."

These days, heroin can sell for near "city price," running about $10 per bag, they said. The officers, who work undercover, say they have even bought a brick -- 50 bags -- locally for $200, or $4 per bag.

And come the first of the month, when welfare checks are disbursed, the dealers are ready for business, they said.

"Nobody's traveling to the cities on the first, because everybody's here and they're stocked," Palka said. "Because they know that come midnight -- and I'm talking at midnight -- you can go to the MAC machines at that time, and they're ready."

The addiction epidemic

The DEA links the surge in heroin use to what it calls the nation's "prescription epidemic." People who wouldn't normally try heroin get hooked first on prescription painkillers, sometimes because of an injury. When the doctor cuts them off, they move on to heroin.

"People get addicted that normally wouldn't be their target audience, so that addiction spreads out into socioeconomically different areas," the DEA official said. "People get exposed and addicted to the prescription drugs like Oxycodone and those kind of things. This is another opiate based product, but it's cheaper and easier to get really."

According to the National Institute on Drug Abuse, almost half of young heroin users reported in recent surveys they abused prescription drugs before starting heroin.

Palka said the typical user in Luzerne County is local, someone who grew up in the area and "somehow lost their way." Most times they first try heroin when something else is at play -- they're drinking or smoking marijuana or possibly had a recent trauma like a break-up, he said.

Once is often all it takes.

"The majority of them would say that they started by snorting," Kotchik said. "They will tell you, 'Oh my God, I was so sick. But when it was done and over with, I craved it.' And that is the addictiveness of it."

In the beginning, most users will use only part of one bag. But that doesn't satisfy for long. The detectives spoke of a man who was using 10 bags in one shot. And he needed three shots every day.

Daily tab: $300.

"Where do you get that money?" Palka said. "The time that you're high, you can't do nothing -- you're laying on a bed somewhere in euphoria. And the next thing you know you're getting up, and the next thing you think of is, 'I gotta get high again.'"

The dealers help drive demand with a marketing scheme designed to improve sales. They release new bags -- they go by names like Aftershock or Superman -- that are highly potent. Everyone wants it, and the dealers rake in the cash.

Then they start cutting the dope, making it weaker so addicts buy more to achieve the same high. Eventually users move on to a stronger substance, which is usually sold by the same dealers.

All the while, they leave behind a wake of crime.

"A lot of the crime is drug-related, because they have to feed that habit. They'll do anything to do it. I think mostly, families really suffer," Kotchik said. "As soon as they start using, they're going to drain whatever they have and then they're going to hit that family and then eventually they have to move on to something else to support their habit."

A 'revolving door' of treatment

More people received treatment in Luzerne County last year for heroin and opiate addictions than for alcohol, said Michael Donahue, the former Luzerne County drug and alcohol administrator.

"What I've seen is just a continuation of the heroin as the primary substance of abuse," Donahue said. "There just doesn't seem to be a let-up."

The Luzerne-Wyoming Counties Drug and Alcohol Program pays for treatment for about 750 people and provides assessments for even more, Ruth Parry, the case management supervisor, said. About 75 to 80 percent of the clients use heroin, and about 80 to 90 percent of them use it intravenously, increasing the potential for disease from sharing needles, she said.

Clients range in age from their teens to their 60s, and many report experimenting with cigarettes, alcohol and marijuana as early as 9 years old, she said.

By high school, some were already using heroin, she said.

"What I have been seeing lately, which has been a little disturbing to me, is the young age of the people who are coming in," said Dr. Lisa Costaris, medical director of the CHOICES Recovery Program methadone clinic in Wilkes-Barre. "I'm seeing a lot of 18, 19, 20-year-olds who are shooting heroin and have been shooting heroin for a couple of years already. And that is certainly concerning to me."

Parry said the fact that heroin use is increasing makes gangs "hugely present" in the region.

"It is definitely easier for a high school student at this point to obtain heroin than alcohol," she said.

Jeanne Stapleton, the vice president and clinical director of Serento Gardens in Hazleton, said the rehabilitation facility is also seeing an increase in heroin addicts, calling use of the drug "widespread."

The facility sees several people per week looking for help overcoming heroin addictions, she said. Some have hit bottom and are genuinely in need of help. Others have been arrested and are looking for a way out. For them, treatment can be a "revolving door," she said.

Even police activity can impact treatment centers, she said.

"We kind of can tell when the supply of heroin is not readily available in the community because we see a lot of individuals coming in looking for detox," Stapleton said. "A lot of times we see these individuals when they're in their crisis. They're starting to withdraw and they don't want to feel the symptoms."

Stapleton's facility does not provide methadone or Suboxone, the prescription drugs used to reduce symptoms of heroin withdrawal, but it can refer people to facilities that do, she said.

The county has two methadone clinics: CHOICES and Miner's Medical in Ashley.

CHOICES, which opened in 2004, is equipped to handle more than 200 patients -- and averages multiple calls a day from prospective intakes, clinical supervisor Ashely Wirbicki said.

The clinic, which also works with patients to address their housing, legal, financial issues, frequently has a waiting list, she said.

"Sometimes the waiting list is a week," she said. "Sometimes the waiting list can go as long as a month."

About 70 percent of patients are women because many women heroin addicts seek methadone treatment while they are pregnant.

County officials have taken another approach to the problem. The Luzerne County Treatment Court was created in 2006 after a study showed 85 percent of inmates arrested for drug- or alcohol-related crimes were rearrested for similar crimes after their release.

The program has so far graduated 119 people and boasts an astonishingly low 12 percent recidivism rate, said Kelly Cesari, treatment court coordinator.

There, as elsewhere, the No. 1 drug of choice is heroin, she said.

"We take high-risk, high-needs offenders, meaning they're difficult to treat and high-needs meaning they need a lot of treatment," Cesari said. "So we basically take the hardest cases in that respect -- people who have serious addiction problems and related criminal justice problems."

The program has a caseload of about 50 defendants -- people charged with violent crimes or sex offenses are not eligible -- who can have their charges expunged upon successful completion of the program, which entails, drug treatment, drug testing and schooling, she said.

'Why didn't he get better?'

Users can only get help when they truly want it. Sometimes not even then.

Erik Coolbaugh went through cycles of recovery and relapse. He dropped out of high school but later received an equivalency diploma. He would get thrown out of the house and come back, get a job and then get fired, his mother said.

He was in and out of jail and rehab.

He would ask for money to pay bills like the car insurance until he got cut off. Then he'd ask for just a few dollars in gas money.

"It was a constant run," Carol Coolbaugh said. "The night he died, we were looking at his cellphone, and there were calls every three seconds looking for somebody, for something."

The day he died, his landlord in Avoca saw him leave with someone around noon, his mother said. The landlord later saw his car there although Erik Coolbaugh was supposed to be at work.

Erik Coolbaugh was found dead on the couch. At the time, he was in recovery in a methadone program, his mother said.

His toxicology report showed he had methadone, cocaine and marijuana in his system, his mother said.

"At first when I got the news, I was sad," Carol Coolbaugh said. "It's kind of like cancer when you see somebody struggling for years and you say, 'Well thank God. It's over.' If that's the life he was going to live, well, he's in a better place. And then my whole mind-set changed because I'm like, 'Well, why didn't he get better?'"

The hardest part was the toll his addiction took on the family, including Erik Coolbaugh's three children who are now 14, 11 and 10 years old.

"It devoured all of our lives. It devoured all of our attention. It took away attention from the other children and my husband and our life," Carol Coolbaugh said.

She says she believes someone else was with her son before his death, because opened packages of heroin were found in the apartment and Erik Coolbaugh couldn't take it because of the methadone, she said.

"He didn't have any heroin in his system, so somebody ran," Carol Coolbaugh said. "Somebody got scared and ran."

She said she thinks a medical amnesty law for drugs could have saved her son's life that day.

After Erik's death, Carol Coolbaugh joined the Grief Recovery After Substance Passing group, trying to help other parents move past pain she says changes over time but never goes away.

She wants people to know Erik Coolbaugh existed. He was more than just a number.

"He wasn't a scumbag. He wasn't a loser. He was a dad and son and father a brother and uncle. He was a lot of other things beside being just a drug addict," Carol Coolbaugh said.

"He had a disease, and he really did try," she said. "He had an 18-year addiction, and it just consumed his whole life."

[email protected]

570-821-2058, @cvjimhalpin

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