Aaron Smith held up a needle he used to shoot heroin. “More or less this is all you need,” the 22-year-old said.
It's what he called a “tool of the trade.”
Smith started using heroin only a year ago. “It snowballed really quickly," he said. "To the point where I’d get up every day and my number one task was heroin.”
Like many heroin addicts, Smith said his addiction started with prescription pain killers. Heroin provides an almost identical high to these prescription opioids. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), four out of five new users start with prescription pills and then move on to heroin. And according to the DEA, heroin is now much cheaper to buy on the streets than black market prescription pain killers.
Smith grew up in Rochester and Seabrook, New Hampshire. He said he enjoyed a typical New England childhood, playing football and little league, camping with his father. He met his wife Kaitlin Norton, 21, in grade school and together they had their son, Camden.
“We’ve known each other basically our whole lives,” Norton said. “He’s just a good person. A genuinely good person.”
But Norton too was a heroin addict. She and Aaron started using together. Their addiction has put their young family at risk. They both want to get better to properly raise their young son, but every day is a struggle to stop.
It’s a familiar story to many American families. ABC News “20/20” has been following families affected by the growing heroin epidemic in this country for over a year.
Today, 90 percent of first-time users are white -- young men and women in their 20s mostly living in suburban and rural areas, according to the medical journal JAMA Psychiatry.
But it’s affecting children, too. In the U.S., a baby suffering from opiate withdrawal is born every 25 minutes, according to the National Institute on Drug Abuse. The Children’s Hospital at Dartmouth Hitchcock Medical Center uses morphine to help wean newborns off opiates when they’re born with severe withdrawal symptoms such as irritability, fussiness or problems with breathing.
“It’s something that’s been in use for a very long time,” said Dr. Bonny Whalen, the hospital’s Newborn Nursery Medical Director. “It’s really something that makes them feel better and makes their withdrawal less. There are some centers that use methadone to treat withdrawal rather than morphine and there’s been different studies and hasn’t really shown one to be more effective than another."
In 2013, when physicians at the hospital began to see a rise in opiate-addicted pregnant women, they initiated the Dartmouth-Hitchcock Perinatal Addiction Treatment Program. It’s a rare treatment center in the region where pregnant women and young mothers can get counseling, medical check-ups, and medication to help curb their heroin cravings.
Cathy Milliken is the director of the program’s addiction treatment program. She said these medications can help save lives.
“When women are pregnant, if they were to quit heroin cold-turkey, they could miscarry,” she said. “It’s a dangerous strategy. Having someone take Subutex is a safer way for them to move through their pregnancy.”
Subutex is a medication commonly prescribed to recovering addicts to curb withdrawal.
For long-term success, she added, “Medications are helpful, but optimal treatment is really when you’re doing talk therapy with someone.”
RA review of the research published by the Harvard Review of Psychiatry found that pills like these can at least double the chances of staying clean, when combined with counseling and behavioral therapies. In 2014, over 1.3 million people received behavioral health services at health centers. One of the Dartmouth program’s patients, 21-year-old Savannah, said she was so high on heroin that she didn’t realize that she was five months pregnant. That was the point when she stopped using. But she said it’s been a daily struggle to stay clean. She was given Subutex, but she is only able to fill her dose one day at a time.
Every day, Savannah and her baby’s father, Matt, struggle to come up with the $17 it costs for her daily prescription. For Matt, 25, who earns $10 an hour fixing tractors and loading hay, the cost is burden.
When she runs out of Subutex, Savannah immediately goes into withdrawal. It’s called “dopesick.”
“It’s like restless, it’s like nauseous,” she said. “It’s your stomach, it’s your head, it’s your body.”
Matt, a former addict who once sold drugs to support his habit, decided to turn himself in for criminal charges in Vermont stemming from a probation violation. When a judge set Matt’s bail at $5,000, they had no money to cover it and he was sent to jail.
Savannah and Matt’s baby now lives with her grandmother.
Around the country, adequate and affordable addiction treatment can be hard to find, but it’s especially difficult in New Hampshire. The Granite State ranks 49th in the nation for access to treatment. When ABC News called residential rehabs around the state, we found waitlists ranging from a few weeks to two months.
Aaron Smith made his own calls, desperate for help. He called several facilities three times a day. And after three weeks of searching, he finally found a bed with the help of a local activist, Kerry Norton (no relation to Kaitlin). She’s a prenatal nurse who dedicates her free time to helping young addicts access care. She also helped Aaron’s wife Kaitlin find a bed at a 28 day residential rehab program.
Aaron had to wait two days before he could enter his own rehab program. During that time, he said he wanted to stay clean but struggled with severe withdrawal.
“It just beats the hell out of you. It feels like I was beaten with a sledgehammer,” he said.
He eventually succumbed to the cravings, and even without any money left, he managed to score what he said would be his final fix.
“This is what runs my life,” he said, as he prepared the drugs. “It’s crazy how you get excited doing this. It’s embarrassing saying that but it’s a fact.”
And after shooting up, he had a moment of calm reflection. “I’ll get better, I know I will,” he said. “Period, I want it bad enough I will. I need my son in my life. If I don’t have him in my life at least, then I don’t have life.”
Aaron entered a 28-day program but he only lasted three days. He checked himself out of the program and died of an overdose eight days later.
Like so many residential rehab facilities across the state, they couldn’t provide the prescription medication to manage his severe withdrawal. Experts we spoke with said these medications, like Buprenorphine and Methadone, are essential to effectively wean heroin addicts off of their addiction and to manage their sobriety in the long run.
Outside Aaron’s funeral, Kerry Norton, the local activist who helped him find that bed said “New Hampshire has not provided the access for his treatment that he deserved…we have to do better.” New Hampshire has the third highest overdose death rate in the nation, according to the CDC. Frustrated with the lack of action on the part of lawmakers, Kerry decided to act. For her this fight is personal. Her own son struggled with heroin addiction and survived an overdose. He’s been sober for over a year. But Kerry remembers how hard it was to find treatment for him and knows that more needs to be done.
She and a colleague, Dr. Colene Arnold plan to open a long-term treatment and recovery center in Rochester, New Hampshire, specifically for pregnant moms with substance use disorder and their babies. They named the program “Hope on Haven Hill.” They are so passionate about this project that Dr. Arnold even donated her house to the cause. They hope to open in July, providing round the clock care for 8 women and their babies. They’ve already started a grassroots fundraising campaign and since November they’ve raised $20,000 towards their opening goal of $100,000.
Norton said “Hope on Haven Hill is more than just a home to help eight women.” She insists, “it’s the beginning of a recovery revolution.”
As for Aaron’s wife Kaitlin, she made it through rehab and was reunited with her son. She said she’s still grieving over Aaron’s death and said “it kills me that my son’s never going to have memories with his dad.” But now more than four months sober, she recently landed a job and she says she’s more determined than ever to stay heroin free.