by Jordan Green

There are different doors, different introductions to the drug, different reasons people make the acquaintance of heroin. Personal trauma, mental illness, physical pain or simply idle curiosity. With a sly glance, casual and flirting at first, the suitor initiates the dance. But the user tires of the party the very moment she realizes she has become a prisoner.

Heroin takes all the existential pain of life — whatever the particulars, from one person to the next — and in a flash it is resolved in a brilliant jolt of pleasure and wellbeing. The high becomes the North Star, an all-consuming focal point.

There’s a downside, of course. The sickness of withdrawal is so intense and tormenting that getting the next high becomes imperative. And then chasing the high is almost completely an exercise in avoiding dope sickness.

Whether heroin is a death certificate or a manageable hazard turns out to be incredibly controversial. So too is the matter of whether the personal wreckage surrounding addiction is a direct result of the drug or a byproduct of criminalization and social stigma. Does the drug destroy the lives of every person it touches, or it possible for some to soldier on? There are different narratives and treatises that addicts adopt to make sense of their experience and illuminate a path out of the darkness.

Some people who have used heroin don’t even like the term addict.

“Let’s use scientific language,” said Louise Vincent, a 38-year-old Greensboro native who began using heroin in her twenties. “My brain chemistry is changed. My reward system has been hijacked.”

In any case, the way out is a crooked path, choked with thorns, full of false turns and beset by unsuspected perils.

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Heroin use has been on the rise in recent years, spurred by a crackdown on the abuse of prescription pain medication that has dried up supply and driven up prices, forcing addicts to turn to the cheaper alternative. As the demand for heroin accelerated, the scourge has focused on High Point, a traditional pipeline for the northern Piedmont region strategically located on Interstate 85.

Opioid pain medications still account for the majority of overdose deaths in North Carolina — more than heroin and cocaine combined, according to data collected by the NC State Center for Health Statistics. But beginning in 2011, overdose deaths from prescription pain medication began to taper off as deaths from heroin overdoses showed a marked uptick. The number of heroin deaths in North Carolina increased from 38 in 2010 to 170 a few years later in 2013. And the number of people who have used treatment services for heroin in the state has steadily risen since the late 1990s, from 1,816 in 1997 to 3,560 in 2013.

“We have seen success across the country in curbing the abuse of prescription medication, with monitoring, educating the medical community, running patient names and making sure they’re not getting multiple medications from multiple doctors,” said Jackie Butler, director of client services at Alcohol & Drug Services in High Point. “There’s been more attention because we know that prescription pain medication has been abused. We’ve found that with people who were already addicted and already in trouble, if they can’t get their prescription medication, it was an awful storm waiting to happen because there was a dealer on the street waiting to feed their addiction.”

A rash of overdoses — more than 100, including 14 deaths — in High Point last year prompted a multi-agency investigation that concluded in December with more than 15 arrests, dismantling a network that law enforcement officials said was trafficking roughly 100 grams of heroin into the city every single day.

“High Point has always been a pipeline where heroin comes in,” Butler said. “I think you see that it’s a place where people come to get it from other cities. It’s just the center of where drugs come through from Mexico to the United States.”

Getting drug dealers off the street is only part of the solution, Butler said. Unfortunately, the acceleration of the heroin crisis dovetailed with the recession, when state legislators reduced mental-health funding that had supported treatment services. On a brighter note, advocates and outreach workers have stepped up efforts to distribute the drug naloxone, which can reverse heroin overdoses, to emergency medical technicians and family members of addicts.

The NC Harm Reduction Coalition has seen some of its greatest successes in Guilford County. The coalition reports reversals of as many as 251 overdoses across the state through its distribution of naloxone kits, and that’s only counting addicts, friends and family who went to the trouble to report back to the agency. By far, the largest share of reversals has been reported in Greensboro and High Point — 66 and 47 respectively. That compares to 21 in Charlotte, five in Raleigh, seven in Durham and 15 in Winston-Salem.

At the very least, naloxone can keep addicts alive until they’re ready to seek treatment. Advocates are also heartened by the recent passage of the 911 Good Samaritan Law in North Carolina, which guarantees that a person who calls 911 to report a drug overdose won’t be prosecuted for possession of small amounts of drugs or paraphernalia.

Meanwhile, Butler and others are trying to educate people about heroin to reduce the stigma, so that addicts are not discouraged from seeking help.

“A number of people have chronic pain or suffer from some type of chronic-pain illness,” she said. “They’re taking prescription pain medicine for relief, but they get in trouble and use the drug as a reward. That’s a real challenge — handling pain appropriately. That could happen to any of us. We could be in an automobile accident where we’re in pain, and we could become addicted to the prescription pills, and then make the switch to heroin.”

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Louise Vincent was 13 years old when her bipolar disorder started to manifest. The daughter of a respected English professor at UNCG and a Greensboro School Board member, she had experienced a happy childhood until her interior world inexplicably crashed into darkness.

“It was right around 6th grade,” she recalled. “I just wanted to die. I wasn’t allowed to watch TV, so I didn’t even know what suicide was. I almost believe that drugs saved my life. I think if I hadn’t found them I couldn’t have coped. There was so much chaos in my brain I had to find a way out.”

Although she said she used “heavy drugs” beginning at the age of 13, she didn’t try heroin until she was in her twenties. Someone gave her a pain pill to help cope with a traumatic event. She liked it, and took more. It didn’t take her long to move on to heroin, which was cheaper.

“Pain pills have always been too expensive,” Vincent said. “I’m not an upscale user. There’s a hierarchy in the drug world. People pay a premium for pain pills to not have the stigma [of heroin]. And people who use heroin look down on people who use crack. It’s that ridiculous. With pain pills, people say, ‘It comes from a doctor; it’s better.’ But it’s not your doctor. And did your doctor give you seven prescriptions?”

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Amy Catherine Dean grew up in Kernersville. She ran away from home at the age of 14. Years later her mother would learn that an older boy, perhaps 19 or 20 years old, forced her at gunpoint to perform sex acts.

Dean attended Glenn High School in Kernersville. She was the school mascot and played soccer. She was playing soccer when she was injured, leading to a prescription for pain medication. Her parents were separated, and she started taking un-prescribed pain pills while she was staying with her father, her mother said.

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Misty Sanders and Stacy West attended Trinity High School together outside of High Point in Randolph County. West, who graduated in 2002, was a year behind Sanders, who dropped out before graduating. They were friendly with each other but not especially close. Drugs were not really part of their high school scene.

“A few people smoked pot,” Sanders said. “I didn’t know anyone in school that did any hard drugs. When we all got out of school, we went our separate ways, and some of us went down the wrong path.”

The two “went from friends to family,” as Sanders put it, when West married Sanders’ cousin. Sanders and her boyfriend at the time stayed with West and her husband in their apartment in Archdale for a while. At the time, both of them were abusing prescription pain medication. They used pain pills together, but heroin was still an unforeseen cloud on their horizon.

shotStacy West moved out of her parent’s house at the age of 18. She and a friend rented a house off Centennial Street in High Point. They partied a lot, and were usually game to try any drug their guests brought to the house. They smoked a lot of weed and used Special K, or ketamine a dissociative anesthetic that has developed a reputation as a “date rape” drug.

West met her husband, Scott, through drugs. Scott “was raised in the street life,” West said, in contrast to her own middle-class upbringing, where education and church were important.

“We married, and we calmed down on a lot of stuff,” West said. “I got pregnant. We got awesome jobs. We were going to church.”

But they fell back into their old partying habits. “The first time I got sick, it got to be that instant thing,” West said. “Get a pill.”

One time they discovered an out-of-state clinic where they bought 300 pain pills. They started selling the drugs, but ended up snorting most of the profits. The relationship was physically abusive and they would fight over drugs. Her husband cheated on her, and the marital dysfunction fed into their chemical codependency.

“I wanted it to work,” West said. “The only time we got along was when we were high. That’s sad to say.”

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Although she couldn’t see it at the time, a number of risk factors foreshadowed Misty Sanders’ addiction.

“I was raped when I was 14,” she said. “Honestly, both my parents have struggled with addiction issues. I don’t want to say that environment is everything. My father passed away in 2009. He was a heroin addict. My mom was an addict, but my mom conquered all her demons, and she’s doing phenomenal. She stood up when I was born and put all that behind her.”

Sanders’ father injected heroin the day that he died.

Soon after her father’s death, Sanders started going to the doctor for medication to manage the pain from four slipped discs in her back.

“Access to pain pills was ridiculously easy for me,” she said. “All it took was an MRI and an appointment with a nurse.”

When her use of pain medication spiraled out of control, her doctor cut off the prescription, and Sanders started buying pain pills off the street. She abused pain pills for about three years before she tried heroin for the first time in 2012.

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Like her fellow Trinity High School alum, Stacy West abused pills for about three years until she started using heroin.

There were other drugs besides. And as West and her husband submerged into drug use, their housing situation became increasingly precarious.

“We could never keep a house,” West recalled. “We had an apartment off English Road [in High Point]. We didn’t have electricity, and we were fine with that. That’s when we were using crack.”

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Even before she started using heroin, Misty Sanders lost her children.

“I think my in-laws’ and my husband’s decision to not let me see them was the right thing for my children,” she said. “That’s hard for me to say because I was a great mom.”

Paradoxically, Sanders could more or less manage adult responsibilities while she was abusing pain pills, but she was also coping with an abusive relationship with her husband. When the relationship ended, she found that the freedom from his judgment allowed her to use heroin more frequently.

“If there was ever a drug that was invented for me, it was heroin,” she said. “I’d been through a lot in my life. It took me to a different place. The pain pills didn’t do that. There’s no other drug I can compare it to. I’m not proud to say it: I’ve done every drug there is. Heroin is a different animal. It’s a whole-body high. It’s like everything is right with the world for those first couple seconds, but unfortunately that doesn’t last.”

Addiction presents an impossible contradiction.

“When I talk about chaotic substance use I talk about a feeling that wants to use more than anything in the world and at the same time wanting to get off more than anything,” Louise Vincent said. “I’m praying to get off and at the same time I’m on the phone with my dope dealer. It’s like being split into two persons. Or maybe that’s part of being bipolar.”

Deborah Forrester Dean, Amy Dean’s mother, reflected, “The problem with addiction is people who go through addiction don’t set out to be addicts.”

Stacy West swore to herself that she would never touch a needle.

“I started finding out it was cheaper doing heroin,” she said. “I was terrified of needles. At first my husband gave me the shot, and then I did it myself.”

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For the families of addicts, the disease can only be described as “a pure hell,” Deborah Dean said.

“It put a wedge between my oldest son and myself because he saw me as an enabler,” Dean said. “I saw myself as helping my daughter, who was not able to get her feet on the ground. I helped her with rent and utilities and car payments.”

Finally, she decided enough was enough when she found herself raising her daughter’s son.

“Just living on a shoestring I realized I was not helping her achieve anything,” Dean said. “Then I heard about the boyfriend who was feeding the addiction, and that became a bad situation.”

Amy Dean’s boyfriend beat her when he was high, and Deborah forced her daughter to take out a restraining order against him. But Amy went back with her boyfriend. They wound up getting arrested with drugs in Sanford.

Over time, with the help of other parents, Deborah Dean came to understand the contours of her daughter’s disease.

“I knew that she had nothing to do with what had taken control of her brain,” the mother said. “She needed help, and I couldn’t find it. That was frustrating to me.”

Stacy West has been the child who has stolen from her parents, and who eventually exhausted their patience and forbearance.

“They didn’t turn against me,” she said. “I felt like they turned against me.”

Of all the people who have provided support to Louise Vincent, her mother is the one who has been her rock.

“When I thought I should throw it all in, that woman has really believed in me and been a champion for me,” she said. “She’s made mistakes and sent me to places that f***ed me up. But she did it because she loved me and thought at the time that it was the best thing for me. She has always believed that I am smart enough, that this was a sickness, this is not what I wanted to do, this is not something that I did because I did not love her or my children. She’s the person who gets the late-night phone call when I want to say, ‘F*** it, I can’t do it anymore.’

“I hope I die before she does,” Vincent continued. “I tell her that. I don’t know what I’ll do without her. I’ll be a mess.”

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Stacy West found out she was pregnant when she detoxed from heroin the second time. Her mother took her to an abortion clinic with an offer to pay for the procedure. They looked at the ultrasound together.

“I can’t do this,” Stacy’s mother told her.

“I don’t see how I can have this child,” Stacy said.

“We’ll make this work somehow,” her mother said.

After detoxing, West went back to using pain pills, and then snorting heroin in small quantities.

“It wasn’t too long that she was born — she was healthy, thank God,” West said. “The opiate roller coaster happened again. I started using needles, and I started buying methadone off the street.”

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For some addicts, there’s a clear and often quick trajectory of hitting bottom before recovering. The harsh consequences of addiction seem to supply the clarity needed to make a resolution of sobriety. Others place the emphasis on minimizing harm to addicts while they’re using heroin.

“I believe that you can prevent harm wherever people are,” Louise Vincent said. “It is such a relief for people to be able to tell the truth. In order to get services you have to lie, and say you want to quit.”

Some heroin users seem to fall off the face of the earth as their addiction accelerates. Others manage to function. Vincent, for one, earned a bachelor’s and then a master’s degree while using heroin intermittently.

She teaches classes on prevention of Hepatitis C, a disease common among heroin users because it is transmitted through blood, at the Addiction Recovery Care Association, or ARCA residential treatment program. She distributes naloxone within her network of friends who are active users to reverse overdoses.

“We have an underground needle exchange, so they can get sterile supplies,” Vincent said. “They don’t promote use; they prevent disease and they link people to services. It’s still illegal in North Carolina. We hook them up with people who can help them. We make sure they know how to use naloxone.”

Vincent rejects the notion that recovery is an all-or-nothing proposition.

“The times I’ve had very traumatic experiences like death or a child gets taken away, you can look at my substance use and see a peak; you can see I use chaotically,” she said. “There’s other times when I’ve been in a good place, and I’ve been able to use moderately.”

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Stacy West’s family tried to stage an intervention at church. They wanted her to go into a residential treatment program, but Stacy resisted the idea because she was afraid of losing her children. The disagreement caused a fight, and Stacy got upset and stormed out. As she was driving out of the church parking lot, she almost ran over her mother and one of her mother’s friends.

Meanwhile, her parents placed a call to Child Protective Services. It wasn’t long before West and her husband heard the dreaded knock at the door.

The two girls at first went to stay with West’s mother-in-law, but she got sick with cancer. Eventually, they wound up staying with West’s parents.

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As a traditional supply point, High Point has always been an attractive location for addicts to buy heroin that’s both cheaper and more potent than what’s available in other parts of North Carolina.

“I know that it was cheaper for me to get it in High Point versus going to other places,” Misty Sanders said. “It’s insanely cheap, strong and good.”

She lived for a while in Myrtle Beach, but almost always came back to High Point to score.

“I’ve done heroin from South Carolina,” Sanders said. “None of it compared to what I got in High Point. I would drive up and get the drugs for the weekend, and go back. That’s how much better it was.”

When she lived in Thomasville, Sanders would come to High Point to get heroin, rarely waiting to get back home before shooting up.

“I used everywhere: gas station bathrooms, Walmart bathrooms,” she said. “I’d rent a room at a motel off Brentwood and get high for days. I’ve used in cars in parking lots. Most addicts carry around a bottle of water. Normally, when we get it we’re sick at the time, so we’re gonna use it at the dealer’s house or in the car.

“I’ve had so many run-ins with the police it’s ridiculous,” Sanders continued. “They came in my motel room. The officer asked me if I had heroin. I said I had needles in the room but no heroin, which was the truth.”

Sanders has had too many run-ins with law enforcement to count. But one encounter with the High Point police stands out.

“One of them called out my dealer’s name,” she said. “He said, ‘I hope you’re not buying from him because his dope is killing people.’ I said to myself: ‘Oh my, that is my drug dealer.’”

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People who use heroin inevitably find themselves in jail at some point during the course of their addictions, whether from stealing or committing fraud to support their habit, or simply from possessing an illegal substance.

“The stigma on addiction is insane, and it’s insane the way people treat you because addiction is criminalized,” Louise Vincent said. “I have a lengthy criminal record, but it’s all for drug paraphernalia and drug use. I’ve never stole from anyone. What my criminal record is, is basically a hospital record.”

Stacy West’s experience with jail predated her use of heroin. When she was in her early twenties she stole handguns from her father, and someone in turn stole the guns from her.

“You know, I guess I just took them for my friends,” West said. “My dad took out larceny charges against me. I spent eight months in jail. I did a lot of hurtful things. My husband’s brother had the gun. I never told on his brother. I took the rap.”

The eight months West spent in the Randolph County Jail didn’t pose any deterrent to her later use of heroin.

“The officers loved me,” she recalled. “They’d say, ‘You’re a good girl. What are you doing here?’… I got along with everybody, all the inmates. Even a girl in there for murder. She was sweet as can be.”

If anything, Misty Sanders said, jail gives addicts an opportunity to detox, albeit with limited success.

“I understand why people go back to using,” she said. “There’s no resources. They get clean, but they don’t have any family to help them at that point. You have people who are in jail for three days. They detox when they’re in there, but then they get out and start using again. Most of the girls I’ve seen in jail were addicts of pain pills and heroin. If there were more resources available they wouldn’t go back to using.”

Maj. Chuck Williamson, the commander of the Guilford County Jail’s court services bureau, acknowledged that jail can only do so much to help addicts. The new jail in Greensboro has medical housing available for inmates who are experiencing severe and life-threatening symptoms from heroin withdrawal. The court services bureau looks at inmates’ charges to flag those who are in jail for drug-related offenses, and if the inmate confirms their addiction they receive a referral to a special drug court. Williamson said the purpose of drug court is to divert addicts from jail as long as they comply with a treatment program. The jail also refers inmates who are struggling with addiction to narcotics anonymous and other support groups.

“There’s a lot of social issues that go along with criminal activity,” said Williamson, who has 26 years of experience in the profession. “Let’s say I’m an addict. Whatever offense I’ve committed, it’s probably because I’m using and I’m trying to survive. I’ve cut off all ties to family and friends. I have a brother in this jail right now. They’ve cut off all ties to their family. They’ve stolen from them. A lot of them may not have housing, may not have income to meet their basic needs. You can refer them to a meeting. If there’s not resources to connect them to the basic needs of food, housing and security, they’re going to go back to what they know.”

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Stacy West used methadone, an opioid medication that reduces symptoms from heroin withdrawal, to remain functional. She worked as a stripper to finance her habit. Her husband did sporadic tree work to earn money for drugs.

“After I got back from the club I’d get crack to cancel out the methadone, so I could feel the high from heroin,” West recalled. “I was dancing and working eight months after our kids were taken. I was mad at myself. I was mad at my family. I was mad at the world. I attempted suicide. I got to a point where I didn’t want to live…. The needle became my best friend.”

She had lost her entire support network, except for her husband.

“Scott was the only person I had besides the drug,” she said. “I hated him for everything we went through. I singled him out and focused on the drug.”

Misty Sanders’ addiction also reached a suicidal level.

“You don’t want to be sick,” she said. “Whatever you’re running from, you don’t want to feel that. I was trying to die. I’ve overdosed several times. When I was using heavily I was hoping that that last shot would be my last shot so I wouldn’t have to do that no more.”

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“Jails, institutions and death — that’s the three ways to go.”

The refrain is drilled into every addict who signs up for a 12-step program.

“I’d been to jail and institutions, so death was the only thing left,” Stacy West said.

Death ended Amy Dean’s struggle with heroin. She died of an overdose at the age of 32 on June 15, 2012 while living with her boyfriend in High Point.

“I mourn the daughter I had before she was ever prescribed that medication,” Deborah Dean said. “I don’t mourn the addict. She had lost the ability to make normal, rational decisions.

“This is a disease,” she added. “This was my child who was stealing my medications and pawning my possessions. They’re hard to accept and forgive an addict, but an addict will do anything to provide the fuel to continue that addiction.”

Looking back today, Misty Sanders and Stacy West can easily imagine being Amy Dean. They both believe they had to hit the proverbial rock bottom before they could quit their habit for good.

“I lost everything: my children, my home, my family,” Sanders said. “That was when I realized I had a serious problem, and if I didn’t step up I was going to die.”

West said, “I keep telling myself if I use heroin again I’m going to die so that I’ll be scared to touch it again. It’s easy for me to go back there and use it. I choose not to.”

But sometimes recovery is not about reaching a bottom, said Louise Vincent, who has experienced at least a few.

“It’s about finding passion, and finding something to live for,” she said. “When I found things l loved to do and found an enjoyment of life, I found that sitting in the bathroom getting high was getting in the way. Drugs got in the way of my dream.”

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Stacy West checked herself into High Point Regional Hospital for her third attempt at detox. After she completed the five-day program, her father picked her up and paid for her to stay at a motel in Thomasville. The next day, she began to experience withdrawal again. Feeling as if she might die, she called her father and begged him to take her back to the hospital.

Meanwhile, West’s husband had undergone residential treatment at ARCA. West stayed at the motel for two weeks, but when her husband got out of treatment, their only housing option was a homeless shelter in Lexington. They had to submit to drug testing and Breathalyzers to stay.

Then her husband relapsed and they were kicked out of the shelter.

“We moved in with his brother,” West recalled. “I started seeing all the signs. He’d come home from work with no money. I’d ask him where the money was, and he would lie to me. I suggested that we go stay with my parents. I told him I was packing our bags. I lied to him. I only packed my own bags, and I left without him. And then I called him from their house. I said, ‘Scott, I can’t do this anymore.’”

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Officer Derrick McNeal, with the High Point Police Department, had known Misty Sanders since her days of abusing pills. When McNeil encountered Sanders one day in the spring of 2013, he shook his head as he took note of the track marks on her arms.

“You’re better than that,” McNeal told Sanders. “This is not you. This doesn’t have to be the end of the road for you.”

The encouraging words gave Sanders hope.

“Every run-in I’ve ever had with [High Point police officers], they never treated me like a junkie,” she said. “There’s several officers who go above and beyond. Even though I ended up with charges, I was treated like a human being, and that made a difference.”

She used her last $48 bag of heroin, and the next morning she quit for good.

Sanders spent nine days away from High Point “sick as a dog,” as she put it. Then her aunt took her to the detox facility at High Point Regional Hospital. By the time she completed the detox program, she had been clean for two weeks.

“I ended up having to go to jail because I had a warrant issued for my arrest,” Sanders said. “I think that probably saved my life. By the time I got out of jail, I had a month clean, and it was a lot easier from that point.”

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Louise Vincent, for one, doesn’t like to be asked when she last used drugs.

“When I talk about recovery, I talk about making positive changes in my life for the past 10 years,” she said. “That doesn’t have anything to do with how many days, hours, years I haven’t put drugs in my body. It takes the emphasis off the idea that abstinence is the only acceptable path.

“I will say that I am taking care of my daughter,” she added. “I’m an active member of my family.”

She enjoys the respect of her colleagues at work, and gets a sense of gratification from her outreach with active heroin users.

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Stacy West, now 31, has moved back in with her parents. In her two years of sobriety, she has obtained a CNA license and bought her father’s car, which advertises his Allstate insurance brokerage. She works full-time with dementia patients as a private-care nurse, and is on call at a nursing home.

“I discovered something that I love is taking care of people,” she said. “I work two jobs, always on the go. That’s what I need to do, is keep busy.”

Her husband is more or less out of the picture, and West filed for divorce a couple weeks ago. They have no possessions to argue over, except maybe some furniture her parents have been keeping in storage.

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Misty Sanders, also 31, recently left the Triad, so she could move in with her new boyfriend. They live in western North Carolina in a town she would prefer not to disclose. Her criminal record has so far prevented her from obtaining employment.

She looks back on the pain medication prescription that set her on the road to heroin addiction as entirely unnecessary.

“I don’t think I should have went on long-term pain management,” she said. “I’m not on any drugs or prescriptions now. I still have four slipped discs. I’m better now than when I first went on medication.”

Sanders hasn’t seen her three children in two years, but a legal case with their father is nearing its conclusion, and she expects to be reunited with them eventually.

Patience is Sanders’ posture.

“I didn’t tear my life apart in one day,” she said, “and I’m not going to put it back together in one day.”

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No one believes the tide will be turned against heroin any time soon.

“I don’t know whether it’s the wars we’re fighting or because we’re in Afghanistan,” Louise Vincent said. “I don’t pretend to know. There seems to be a lot of it. And it doesn’t seem to be going anywhere. Opiates have boomed. I think the reason we hear so much about it is because the struggle is so great. Once you’re addicted, it is hell. You either keep using or you’re sick as f***.”

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