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The opioid epidemic is more complicated than the widespread abuse of heroin and prescription painkillers.

Two hundred and fifty nine people died in Milwaukee County from accidental drug overdoses in 2016. Inside the chilly laboratory of the Milwaukee County Medical Examiner’s Office in Downtown Milwaukee, Sara Schreiber, the office’s technical laboratory director, analyzed each case and often found that a majority were caused by “mixed drug” toxicity – often a combination of intoxicants, such as heroin, alcohol and Xanax, that slow the heart and lungs. Yet local and national prevention programs frequently target heroin and opioid abuse in isolation, missing the bigger picture, which is more complex. Heroin is a killer, but it typically works with an accomplice.

Opiate-related deaths continue to rise. In 2012, the Medical Examiner’s Office recorded 147, a figure that seemed elevated at the time. By 2016, it had grown by 61 percent, and while the vast majority of 2016’s drug deaths in Milwaukee County, 88 percent, involved an opiate, only 30 percent of those were caused by opiates alone. The other 70 percent came from mixing the drug with another substance, with fatal results. Out of those cases, 41 percent involved benzodiazepine sedatives, and a quarter involved alcohol.

There are many resources for the widespread prevalence of drug mixing. Heroin users sometimes take anti-anxiety benzodiazepine drugs to intensify a high, combat increasing drug tolerance, and ease the later come-down, but the combination can be deadly. Users may try to get a prescription for the “benzo” or, as is often the case, buy it illegally, which leaves them in the dark about proper dosing. Combine the above substances in high doses, and “breathing has a high likelihood of being stopped,” says Schreiber.

Education is needed, she says, “to make individuals aware of these things upfront before they start using.”

Until recently, public education campaigns in Wisconsin have tended to focus on anti-addiction messaging and stopping usage before it starts. The state Department of Justice has rolled out two major anti-heroin efforts, “The Fly Effect” from 2013 and “Dose of Reality,” expanded in 2016. Aimed at teenagers, The Fly Effect primarily addressed heroin abuse, whereas Dose of Reality concerns the hazards of prescription painkillers.

In an effort to prevent fatalities, a new science-based effort is focusing on what’s commonly referred to as “harm reduction” – strategies to minimize harm for users who are already addicted. The Milwaukee Community Opioid Prevention Effort (COPE) began in 2016 as a joint effort between the city of Milwaukee, the Medical College of Wisconsin’s Department of Emergency Medicine and the Zilber Family Foundation, and the group gathers local data to use in programs that lessen the risks faced by users.

According to Brooke Lerner, deputy director of the Injury Resource Center at MCW, the task force’s advice to known users is as follows: Don’t use alone, try the drug in a small dose first to test its effect and have plenty of Narcan on hand, a drug that treats narcotic overdoses.

COPE doesn’t overlook the danger inherent in mixing drugs, and includes this factor in its handouts for users, listing it as one of the major causes of overdoses.

“It’s going to take the efforts of the government,” Lerner says, “the non-governmental agencies, academics and law enforcement, really coming together to think about how to address this.” ◆


‘Reversal of Fortune’ appears in the September 2017 issue of Milwaukee Magazine.

Find it on newsstands beginning August 28, or buy a copy at milwaukeemag.com/shop.

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