Who's using - and dying of - heroin? You may be surprised

The story of a 62-year-old Main Line yoga teacher who was addicted to (and selling) heroin drew a lot of interest. How unusual is she?

It's long been known that opioid abuse, often fueled by prescription painkillers, is a largely white, suburban phenomenon, particularly among younger men.

But older white women are not immune. Last year, 15 white female heroin users  died of drug overdoses at age 62 nationwide. That was up from four in 2014 and three in 2013. Going back more than a decade, no other year saw more than a single 62-year-old white woman die from heroin, according to federal statistics.

Indeed, heroin-related deaths of white women age 60 and over increased by a factor of 40 in the last decade.

The illegal sales part of Lynne C. Twaddle's story is harder to quantify, and statistics on drug use aren't exacting. But fatality data, which originate with death certificates, get very specific. And heroin is frequently fatal.

The current heroin epidemic was triggered largely by overprescribing of pain pills, synthetic formulations like Percocet and Vicodin that attach to the same opioid receptors in the brain that heroin does. Both types can be addictive, and heroin is the cheap alternative when people dependent on pain pills can no longer find or afford them.

Hardest hit are young adults,  whites, and males. Non-Hispanic white men ages 25 to 34 died of heroin-related overdoses last year at the highest rate of any other group: 21 per 100,000 population.

This rate is  70 times the rate for non-Hispanic white women ages 60 and over.

But deaths in this group have risen five times faster over the last decade compared with young white men.

Twaddle, who has a history of alcoholism, said she was prescribed OxyContin for pain after hip surgeries. She eventually started using heroin and was arrested after selling the drug last summer to a friend (and police informant, accompanied by police) at her home in upscale Wayne.  Prosecutors  recommended five years in prison, but Chester County Judge Phyllis R. Streitel sentenced her through Recovery Court to 90 days in prison and seven years' probation, most of the first year on house arrest.

Her story is one in a years-long series of unexpected consequences from prescribing opioids -- once reserved for only the worst agony, such as cancer pain -- to control more frequent types of pain.

Caleb Alexander, an internal medicine physician and codirector of the Center for Drug Safety and Effectiveness at Johns Hopkins' Bloomberg School of Public Health, pointed to the spread of HIV and hepatitis C (from sharing dirty drug paraphernalia), fast-rising rates of babies born with neonatal abstinence syndrome (drug dependence beginning in the womb based on their mothers' drug use), and even more children in foster care (because their parents were addicted).

He said that  the 21^st Century Cures Act — a wide-ranging bill that President Obama signed Tuesday  and includes $1 billion for addiction prevention and treatment — is "an important start" but "unlikely to be enough."

"Every year I've thought that we've reached an inflection point, and yet things continue to get worse," Alexander said. "I don't expect a huge turnaround on overdose deaths until we rein in prescription opioid overuse and ramp up or increase addiction treatment services."

Far more people —white women in particular —are addicted to prescription painkillers than to heroin.

In the over-60 bracket, women's death rates from opioid pain pills were 10 times higher last year than for heroin.

They have not increased as fast, but the potential pool for future heroin users is enormous.