Word that Oscar-winning actor Philip Seymour Hoffman died of an apparent heroin overdose shocked many people.
Television stations, radio outlets, Internet publications, blog sites, social networks and personal interactions discussed the news and dissected the facts.
"I felt incredibly sad," said Bobbi Douglas, executive director of Liberty Center Connections, a nonprofit agency that provides treatment to addicts through its STEPS program. "I am enough of a movie fan to appreciate what an incredible actor he was, but I am sad whenever someone dies of an addiction."
Back in the 1960s and 1970s, a heroin user was likely connected with the counter-culture, Douglas said. Today, it's a different story.
There's been a huge surge in heroin and opioid use over the past several years -- a 400 percent increase, according to Robert Smedley, associate director of the Mental Health & Recovery Board of Wayne & Holmes Counties.
"It caught me totally off-guard," Douglas said. "I never thought we would see heroin again."
But she, law enforcement, addiction counselors and mental health professionals are seeing it, and it is on the rise. This time, though, it is a problem among middle-class families.
"There has been a dramatic rise in the abuse of prescription opiates, usually Oxycontin, in Ohio since 2007," Smedley said. "There isn't much difference between heroin and Oxycontin, other than heroin is produced from opiate poppies and smuggled illegally in the country, whereas Oxycontin is produced chemically by drug manufacturers.
"Often addicts switch back and forth between the two and turn to heroin when they cannot get prescriptions," he said.
Sometimes, it can be easier to get heroin, Douglas said. When the cost of pain medications becomes too expensive, some opt for the more inexpensive street drug.
Dave Smith, director of Medway Drug Enforcement Agency, said his organization has seen a "substantial increase" in heroin and prescription drug abuse, along with a rise in cocaine.
This is in sharp contrast with the previous year, Smith noted, when Medway was on the offensive against meth labs and saw the drug go mobile with an ability to be produced more easily.
The rise in the prevalence of these drugs locally is in line with what Smith said is happening across the state. With prescription drug abuse, Smith noted, these are typically the opiate-based drugs users obtain when they can't get heroin on the streets.
Just Thursday night, Wayne County Sheriff's deputies (with the help of their new K-9 unit, Rif) arrested a driver of a suspicious vehicle during a traffic stop, and heroin and other paraphernalia were found inside.
"We are still seeing an influx of the 'Detroit boys' coming into Wooster and setting up shop here," Smith said.
Medway agents have seen drug dealers continue to flood Wooster from places like Chicago, Detroit and Columbus for a simple reason -- users in Wayne County will pay more for drugs than dealers can get in those cities.
Wooster Police Chief Matt Fisher said his department has seen the increased drug incidents, too, but the police also have seen a rise in crimes people commit to support their habits.
"Part one" offenses -- the most serious crimes the PD handles -- are up overall, largely due to large increases in theft reports (13 percent increase), burglaries (up 38 percent) and robberies (up 30 percent).
"Those (drug cases) unfortunately tend to lead to other crimes by people looking to fuel their habits," Fisher said.
The police also worked with agencies such as Medway to execute more search warrants within the last year. Narcotics have been found, along with firearms in several cases.
"I believe it is not just the price of pain medication that drives some people (to) switch to heroin. It also occurs when people are no longer able to secure prescriptions for controlled substances and consequently resort to illegal substitutes," said Susan Buchwalter, executive director of The Counseling Center of Wayne & Holmes Counties.
In a Jan. 14 presentation by Gov. John Kasich's Opiate Action Team, it was noted prescriptions for opioid pain medication are on the rise, and so is the rate of unintentional drug poisonings. In 1999, there were about 18,000 grams of prescribed opioids for every 100,000 residents in Ohio. Nearly three people in 100,000 died to unintentional drug poisoning.
As the grams prescribed by physicians per 100,000 people has increased, so, too, have the deaths. The rate is directly proportionate to the increase in prescription opioids, based on data from the U.S. Department of Justice, the U.S. Drug Enforcement Agency and the Automation of Reports and Consolidated Orders System, a database that tracks the sale of controlled substances.
In 2007, the last year for which actual numbers were available, there were nearly 12 deaths per 100,000 population and more than 71,000 grams prescribed per 100,000.
"The Counseling Center has a number of psychiatrists who prescribe medication to persons with psychiatric concerns, and we have noticed what appears to be an increase in the number of drug-seeking persons contacting us for services," Buchwalter said. "Some are quite distressed when they learn that we do not prescribe pain medication."
STEPS at Liberty Center uses a medically assisted treatment program to help those who are addicted, said Melinda Kauffman, clinical care coordinator.
"We can hold onto our patients pretty tightly," Douglas said.
"Opiates are used to treat patients by doctors in a very safe way," Smedley said. "The chemical ingredients are known and the effect predictable. Heroin can vary widely in potency and users may end up overdosing simply because they do not know the potency when using."
The Mental Health & Recovery Board funded two pilot programs in 2013 geared toward opiate users. One is for assessments at Children Services in Wayne and Holmes counties, where there has been a dramatic increase in the permanent custody cases due to opiate abuse of the parents, Smedley said. Anazao, formerly Your Human Resource Center, is administering the program.
The other was to expand medically assisted treatment at STEPS, and this was prompted by information received from employers about the increase of urine failures by job applicants, Smedley added.
As people learned of Hoffman's death, in which reports indicated he had a needle sticking out of his arm, some people could not comprehend how such a successful actor could be addicted to heroin, Douglas said. "A lot of people are predisposed to an addiction, and once you start using, the brain gets rewired."
When people use heroin or other opiates, it creates changes in the chemistry of their brains, Kauffman said. There are also a number of physical signs, like weight loss because of not having an appetite, the appearance of being sick, sunken eyes, needle marks and infections.
There are psychological changes, too.
"Everything is put on the back burner," Kauffman said. "Everything (the person does) is for that drug. The brain believes it needs that drug to live."
"As long as we continue to stigmatize addicts as bad people instead of sick people, they won't get help because of the shame," Douglas said.
If family members suspect a loved one might be addicted, they can call Kauffman to discuss the matter. As for addicts, generally something has to happen for them to seek help, she said.
For more information about substance abuse treatment options, call STEPS at 330-264-8498.
Reporter Bobby Warren can be reached at 330-287-1639 or firstname.lastname@example.org. He is @BobbyWarrenTDR on Twitter.