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The Faces of Death

Three-ring binder shows tragic consequences of heroin use
by: Mara Stine Multnomah County Deputy DA Ryan Lufkin tries to keep a photo of each heroin overdose victim whose death he helps investigate. This is one page in a three-ring notebook filled with pictures and paperwork.

Part 2 of 2

• Heroin deals are going down as you shop for new clothes at Gresham Station, while you pick up your child from grade school, while you load groceries into your car. And those deals are killing people.

The Outlook investigated last month's bust involving a large-scale heroin operation operating in East County. The result is a two-part series:

TODAY: Police and prosecutors explain why heroin is so hot in the Portland-metro area, why it's so dangerous and what needs to be done about it.

MAY 28: Officials are joining forces to hold three alleged heroin dealers from Troutdale accountable for two drug overdoses, one in Gresham.

The three-ring binder on Ryan Lufkin's desk is a lot like the 'Faces of Meth' campaign from a few years back - mug shots chronicling the ravages of methamphetamine addiction.

Missing teeth. Scarred skin. Women in their 20s who appeared to be in their 50s.

Lufkin's binder shows a different outcome.

Each of the faces in the binder is that of a person who died of a heroin overdose - an overdose Lufkin has investigated as a Multnomah County deputy district attorney.

Now, Lufkin is teaming with Gresham Police Detective Bob Peterson and the U.S. Attorney's office to hold three Troutdale men accountable for dealing fatal doses of heroin to two Portland men.

Police on March 25 arrested Arturo Bugarin-Cruz, 25, and on April 14 arrested Miguel 'Alex' Celis-Real, 18, and Heriberto Varas-Medina, 25, on drug charges and allegations that they supplied the fatal doses of heroin.

Jason Greer, 33, of Portland died on Jan. 9. The other man, Jeremiah Alden, 32, died in the toilet of the men's room of a McDonald's in Gresham's Rockwood area in late February.

Prosecutors are increasingly trying to indict drug dealers of fatal drug overdoses under the Len Bias law. Named for the University of Maryland basketball star who died in 1986 of a cocaine overdose, the Len Bias law creates tougher penalties for distributing drugs that cause a death - a minimum of 20 years in prison with a maximum of life imprisonment.

Prosecution difficult

But prosecuting drug dealers for fatalities caused by their product is difficult. Witnesses - fellow drug addicts who depend on the dealers for their fixes - tend to be uncooperative, Lufkin said.

Sometimes, Lufkin shows reluctant witnesses his binder, complete with police reports detailing how a body was found and pictures of the victim.

He shows it to judges in an effort to get higher sentences.

And he shows it to heroin addicts he's prosecuting on drug charges in hopes of scaring them straight.

'So they could see what their report would look like,' Lufkin said. 'I've had several users find friends of theirs they didn't know had died. Some have come to tears reviewing it. That can be a very potent message.'

Lufkin and Peterson said prosecuting heroin dealers to the full extent possible is essential. The message: 'The days of them being able to sell a person drugs and not deal with the consequences of their behavior are over,' Lufkin said.

It, too, sends a very potent message to the dealers and to the community at large, including the friends and family of those who died.

'This is not a victimless crime,' Lufkin said. 'The number of fatal heroin overdoses far outstrips the number of homicides in Multnomah County.'

But society tends to dismiss drug overdose deaths as different from a homicide on the grounds that the addict chose to take drugs, Lufkin said. He, however, meets the loved ones they leave behind - loved ones who know the deceased as fathers and mothers, sons and daughters, husbands and wives, brothers and sisters.

County's most lethal street drug

Heroin's danger is nothing new. Throughout the 1990s, heroin overdoses made up the bulk of drug-related deaths in Multnomah County, spiking in 1999, highlighting the time's heroin chic trend, Lufkin said.

While heroin continued to be the leading substance related to overdose death, the number of such deaths declined from 2000 to 2005. Then methamphetamine-related overdoses increased during the mid-2000s, surpassing fatal heroin overdoses.

Heroin again overtook methamphetamine as the most lethal street drug in Multnomah County in 2007, when 115 fatal heroin overdoses were reported - the highest number since 2000.

Since 2007, heroin has continued its reign as the leading substance related to overdose deaths in Multnomah County, but the numbers are dropping - from 71 in 2008 to 63 in 2009 to 52 in 2010.

Statewide, however, methamphetamine is now responsible for the most drug-related deaths with 106 compared to heroin's 90.

While it's good that heroin deaths are slightly down, Lufkin said, 'The meth number is a bit misleading when compared to heroin because the medical examiner's report is for drug 'involved' deaths,' he said. That includes violent crimes and other fatal events involving drugs, as opposed to purely overdosing and dying from the substance itself. 'Meth users are far more likely to commit violent crimes on one another - jump off buildings, drive crazy, et cetera - than heroin users.'

Lufkin is hopeful the three-year downward trend in fatal heroin overdoses continues.

'Our biggest goal is to bring those numbers down,' he said.

But he's skeptical the trend will continue, considering the county has seized more heroin in the past few years than he's ever seen before. And considering a recent survey in which 43 percent of the heroin users polled said they transitioned from oxycodone.

'That's the new generation,' Lufkin said. 'Those are the kids we're going to start to see at the morgue.'

Oxy, gateway to heroin

Police are seeing a rise in recreational oxycodone use, particularly among teens. They find the pills at home, left over from a legitimate use, and snort, smoke and inject them, Peterson said. Such use can become addictive, requiring users to buy the expensive drug from street-level dealers.

But it's not just recreational oxy users getting caught in heroin's deadly grip. People with legitimate medical issues who are prescribed oxycodone get addicted to the powerful painkiller. When their doctors stop renewing the prescription, some patients turn to street-level drug dealers to buy oxy.

Some also turn to the less expensive, but just as effective, alternative of heroin.

That's what police believe happened to Greer, according to court documents. Greer was 16 when he injured his back lifting weights as a football player at Centennial High School. After back surgery in 2010, he became addicted to prescription opiod medication, such as OxyContin and Percocet. Family suspects he transitioned into heroin to manage his pain.

Thanks to Portland's location along the Interstate-5 corridor - the main drug route for Mexican heroin cartels - heroin is extremely cheap, high quality and readily available in the Portland-metro area, Lufkin said.

'We are a Mecca for heroin users,' he said.

Meth users also are switching to heroin due to the drop in local methamphetamine manufacturing since the state Legislature restricted the availability of ephedrine and pseudoephedrine - key ingredients in the manufacturing of methamphetamine, he added.

'Faces of Death'

But heroin carries a far higher risk of being lethal than meth.

Referring to the 'Faces of Meth' campaign, with its dramatic mug shots showing the physical deterioration of users over time, Lufkin said the three-ring binder documenting heroin overdoses 'is more like the 'Faces of Death' because with heroin, you don't get to live that long. They all die. … It's a terribly, terribly tragic drug.

'The key for us has always been the toxicity of heroin. Heroin alone will kill you,' Lufkin said. 'Meth is also a terrible drug but less toxic in-and-of-itself.'

For starters, heroin purity varies widely, so what might be the right amount for a fix one day can be deadly the next.

Also, an addict's tolerance for the drug drops while the addict is in jail, but users don't realize it. When they are released, they take their usual dose and end up dead. Detective Peterson noted that Alden, who died in Rockwood, had been in jail for 45 days before he was released, only to overdose the following day.

Lufkin said 22 percent of those who died of heroin overdoses in Multnomah County in 2007 died within 10 days of being released from the Multnomah County Detention Center.

In 2007, Portland also ranked No. 1 in opiode overdose deaths per capita compared to San Francisco, Seattle, Kansas City, St. Louis, Minneapolis and Atlanta.

Possible fix

Oregon's lenient drug laws make it a Mecca not only for users, but for dealers, too.

'Oregon is the only state I know of where you can sell heroin four times and only get probation,' Lufkin said. 'The presumptive sentence is probation and no more than 60 days in jail each time.

'Also, the presumptive sentence maxes out at 12 months for non-violent offenders. Meaning, even for street-level dealers selling heroin more than four times, their presumptive sentence is 12 months incarceration, served entirely in local jails. In fact, assuming the dealer is not convicted of a person-to-person violent felony, a street-level dealer of heroin could perpetually sell heroin - 100, 1,000 times, it wouldn't matter - and the presumptive sentence will never get higher than 12 months in local jail.'

Another problem: A lack of 'enhanced penalties' for drug deals resulting in a death, like the federal government does in the form the Len Bias law.

So since 2006, local prosecutors have worked with federal prosecutors to leverage a possible federal indictment under the Len Bias law to hold local dealers accountable and try to get information on the heroin supply chain, Lufkin said.

Ultimately, Lufkin hopes the Legislature passes 'substantial quantity enhancements' that would create stiffer penalties for those dealing large amounts of oxycodone. This would 'bring that offense in line with other drug sales like unlawful delivery of heroin, cocaine, methamphetamine, LSD, marijuana, et cetera,' Lufkin said.

That way, when repeat offenders sell a substantial quantity of those drugs, they're more likely to be incarcerated and for a longer time, he added.

'This is an important step since it is very clear to us that oxycodone sales are fueling a new generation of opiod addicts, which almost inevitably turn to heroin,' Lufkin said. 'We'd like to go after these oxy dealers before their customers develop a strong addiction to opiates and go to the heroin level.'