Functioning addicts, many with careers and children, make up a large portion of the island’s heroin-using population, according to health experts and police.

“It’s not the guy shooting up in the alley that you saw 20 or 30 years ago,” Edward Schultz, director of Emergency Services for Bermuda Hospitals Board, said of the island’s modern-day heroin user.

“It’s not the kids. It’s the 30 to 50 age group. They’re working — they’re not skid-row types.”

Detective Superintendent Sean Field-Lament of the Bermuda Police Service added that the island had a “very high amount” of functioning addicts, many of whom have affluent backgrounds and large sums of disposable cash. The arrival in Bermuda of fentanyl — a synthetic opioid 50 to 100 times more powerful than morphine — has prompted warnings from health, law enforcement and government representatives over its possible impact.

The drug, which can be fatal even in very small doses, is often used to cut heroin, increasing users’ risk for overdose and death.

Dr Schultz, psychiatrist Grant Farquhar and Mr Field-Lament spoke to The Royal Gazette about Bermuda’s heroin problems, with Dr Farquhar saying that dozens of addicts are currently undergoing treatment, many after using up to $200 a day of the drug. By all indications, according to Dr Schultz, fentanyl has yet to find its way into the country’s heroin supply.

“If there was that much on the street, we would be seeing more serious overdose and deaths,” he said.

Relative to the number of users on the island, there are few heroin overdoses that end up in the emergency room.

“What that says to me, is that the consistency of what’s coming in is very stable,” Dr Schultz said.

“We’ve never had episodes where all of a sudden we get flooded in the ER with five or six people who suddenly got a really strong batch of heroin.”

Unlike other locations, such as Vancouver, where deaths associated with fentanyl have largely been associated with intravenous injection, the majority of Bermuda users today ingest the drug through the nasal cavity, Dr Schultz said.

“They don’t get endocarditis, they don’t get hepatitis, they don’t get abscesses,” he said.

“They work. They’re the thin guy you see at work, who’s pretty fit — he uses heroin.”

Similarly, while the recent popularity of heroin in the United States can be linked with the prescription of powerful opioids for pain — such as OxyContin and Oxycodone, there seems to be little correlation here.

“It’s pretty well controlled here,” Dr Schultz said of prescription opioid sales.

Mr Field-Lament said: “We don’t have what I would say is an over-prescription problem.”

He said the resurgence of heroin on island instead came out of “a really bad spate” of crack cocaine use.

Back in the 1980s, Mr Field-Lament said he was put on a task force to deal with the emerging threat of HIV/Aids.

“In Bermuda, it was literally isolated to intravenous drug use,” he said.

Following the death of many heroin users, crack cocaine began to gain popularity, with heroin mixed in to take the “roller-coaster edge” off the high, the Detective Superintendent said.

Astute dealers realised that heroin was the smart drug to supply.

“Your clientele, you can set a clock to them,” Mr Field-Lament said.

“Bermuda, I would say, has a very high amount of, I call them, functioning addicts.”

“We’re an affluent society with quite a lot of disposable income.”

Dr Farquhar, one of two psychiatrists with the Turning Point Substance Abuse Programme, said addicts could often operate for decades before “hitting bottom”.

“The functioning addicts don’t tend to seek treatment until there’s a problem,” he said. “And that problem might be they’ve been fired from their job, or divorced by their wife, or have lost their house.”

Dr Farquhar said that the majority of 100 people currently in the Methadone Maintenance Treatment Programme are men between the ages of 30 and 50, who have been using heroin for up to 20 years.

Many, he said, report using between $100 and $200 a day worth of the drug.

“You can only, usually, keep that lifestyle up for so long before your body cannot physically handle it any more, or something else happens,” the doctor said.

Those seeking treatment to kick the habit often come with a serious misconception.

“There’s a perception that once you come into detox and you get clean, that’s it, you’re cured,” Dr Farquhar said. “But you’re not.

“That’s just the beginning of the battle, really.

“Bermuda is very small. It’s hard to avoid people. It’s not like you can move to the next city where you don’t have a network of drug dealers and associates.”

And while detox helps rid the user of the physical drive to find their next fix, the impact of — in some cases — decades of drug use has dramatically altered the mind of the addict.

“Over a period of time, over ten or 20 years of heroin use, your brain has changed,” Dr Farquhar said. “So your brain is going to be telling you that you need to have opiates.”

Those ready to clean up should not fear the impact.

“Withdrawing from heroin is not a serious problem,” the doctor said. “Opioids kill you in overdosing — that’s the big danger.”

There is also no waiting list for admission into the Methadone Maintenance Treatment Programme, he said.

“Treatment’s available, and it’s free. Residential rehab is available and it’s free, detox is available and it’s free.”

While popularity may be highest among the 30 to 50-year-old men, use of the drug would seem not to be confined to lower-income earners.

Mr Field-Lament said of those who have fatally overdosed on the drug: “Some have been retired construction workers; we have sons of really affluent rich white people.”

“I can remember overdose deaths in the bathroom at very rich white people’s Christmas parties,” Dr Schultz echoed.

“It’s across the board.”

“Construction, office jobs — could be a doctor,” Dr Farquhar said of the careers of those who have sought treatment. “It basically goes across all social strata.”