Heroin's toll on Long Island is climbing, with hundreds of deaths over two years, an increase in nonfatal overdoses and evidence of a younger clientele, according to public officials, experts and preliminary statistics.

The drug killed a record 121 people in Nassau and Suffolk in 2012 and at least 120 last year -- the two highest totals ever recorded, data show.

The recent rise in heroin deaths comes even as use of the lifesaving intranasal overdose antidote Narcan grows. Hundreds of overdosing patients -- including 563 people in Suffolk County alone -- successfully received the treatment from police and paramedics last year, county officials said.

The fatal and nonfatal heroin overdoses reflect a nationwide trend toward more use of the drug as opioid pain pills -- which offer a similar high -- become harder to obtain amid increased regulations and a dwindling street supply, officials said.

Nassau medical examiner officials said their preliminary 2013 heroin overdose totals could rise by as much as 10 percent when results are complete on remaining cases, while Suffolk officials did not specify the number of outstanding investigations from last year that may yet be classified as heroin deaths.

"As bad as these numbers are, they're only the tip of the iceberg," said Jeffrey Reynolds, executive director of the Long Island Council on Alcoholism and Drug Dependence. "We haven't done enough about this problem on Long Island, and it's gotten progressively worse."


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Worsening trends

Among the trends involving heroin abuse in Nassau and Suffolk:

Long Island drug treatment officials say intake records, state health records and anecdotal evidence suggest treatment for heroin addiction has increased roughly fourfold on the Island since 2011.

Nonfatal heroin overdoses are also rising as cheap, powerful bundles of the drug flood the region, according to officials and records.

Children and young adults are turning to heroin at an earlier age, officials said. Suffolk treatment experts, for example, recently treated a 13-year-old girl for heroin addiction, which the 8th-grader developed after using MDMA -- also known as Molly or Ecstasy -- and cocaine, said John Venza, vice president of Adolescent Services for Outreach Development Corp., a substance-abuse treatment organization with offices on Long Island.


Despite its large swaths of middle- and upper-income areas -- including some of the wealthiest neighborhoods in the country -- Long Island has become a thriving market for heroin dealers who use the Long Island Expressway to move heroin back and forth from New York City, leading Queens prosecutors to dub the road the "Heroin Highway" in 2012, officials said.

A bag of heroin is usually sold for just $6 to $10 on the Island because of its proximity to the city, one of the country's largest heroin markets. The same size bag, which usually amounts to a single dose, can be sold for $30 or more in rural sections of the tristate area and New England, where supply chains are less accessible, officials said.

"These numbers demonstrate that we have to redouble our efforts to crack down on those who deal heroin while providing needed treatment for those who are addicted," state Sen. Phil Boyle (R-Islip), chairman of the Senate's Committee on Alcoholism and Drug Abuse, said of heroin deaths. "This is an epidemic in the truest sense of the word."

Heroin is considered one of the world's most powerful and addictive drugs, leading one out of every four people who try it to become addicted, according to research published by the U.S. government. Users' tolerance typically builds quickly, requiring them to use an ever-increasing amount of heroin to produce the same high.

A typical heroin addict on Long Island in the past might use six to eight bags of the drug per day, authorities said, but with a glut of cheap product on the market, that number is on the rise.

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"The quantity of heroin they're using right now is staggering," Reynolds said of addicts on Long Island. "Ten to fifteen bags is now the norm. It's a mind-blowing amount of drugs."


A dual problem

Long Island officials have fought the twin scourges of heroin and pain pill abuse for nearly a decade, as increased access to legal opiates such as oxycodone and hydrocodone created a new generation of addicts.

Parents would often store the pills in medicine cabinets, where their children could steal them to use or sell. Some addicts unable to get the drugs from doctors turned to home invasions and pharmacy robberies to obtain pills, with sometimes devastating results.

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Pain pill addict David Laffer murdered four people during the robbery of a Medford pharmacy in June 2011, and federal agent John Capano was mistakenly killed in December 2011 by a retired Nassau County police officer during a struggle with a man who had allegedly just robbed a Seaford pharmacy.

Those events spurred a series of crackdowns and reforms, including the creation of a statewide, real-time prescription tracking database. Pain pill supplies have decreased on the black market as a result, records show, sending their price soaring, up to $20 to $80 per pill, depending on their strength.

Drugmakers also increasingly used tamper-resistant formulas for their opioids, making them harder to snort or inject. All but shut out of the pill market, many opiate addicts increasingly turned toward heroin in its place, said police, public officials and treatment experts.

In accordance with that trend, officials said, overdose deaths involving opioid pills decreased in 2013. In Suffolk, non-heroin opiate deaths fell to 104 last year from 151 in 2012, records show. In Nassau, non-heroin opiate deaths fell to 67 in 2013 from 101 in 2012, records show.


Kids are particularly at risk

Current and former heroin addicts said the drug can be particularly alluring to young Long Islanders because of a lack of nightlife activities in the area -- particularly in some rural stretches of land found in Suffolk County.

"Long Island is a nice place to live, but it's kind of lacking in things for young people to do, which makes drug experimentation more attractive here," said Beth O'Riley, 25, of Hauppauge, a visual artist who said she was a former heroin and pill addict.

Among those who died in 2012 from heroin-related overdoses was Megan Roethel, 22, of Huntington, who began using the drug when it became too difficult to buy pain pills, said her mother, Susan Roethel.

"Young people are not afraid of heroin anymore," Roethel said. "And it's everywhere."

Jamie Bogenschutz, executive director of the YES Counseling Center in Massapequa, said a number of local heroin users are overdosing after vowing to shoot up one final time before entering treatment.

"A lot of them say, 'I just need to do this one more time and then I'll get help,' " Bogenschutz said. "And it's that one more time they don't always survive."

In a statement responding to the overdose numbers, Nassau County Executive Edward Mangano said, "Nassau County leads the nation with its aggressive substance abuse prevention, education and enforcement efforts" and hailed the county's Prescription Drug Abuse Task Force and Heroin Prevention Task Force as helping to prevent more overdoses.

Suffolk County Executive Steve Bellone said in a statement that "heroin addiction and abuse is a public health crisis that must be tackled from multiple levels" and lauded the county's expanded use of Narcan, along with a law he supported to help those saved by the antidote receive additional treatment.

Suffolk police said the number of heroin-related arrests rose to 1,386 in the county in 2013 from 1,266 in 2012. The total was 1,051 in 2011.

The number of heroin-related arrests by Nassau police rose significantly as well, to 500 in 2013 from 427 in 2012, records show. The total was 228 in 2011.

Reynolds said the latest heroin overdose numbers should serve as a wake-up call for Long Island's public officials, politicians and parents.

"This is clearly one of Long Island's most pressing public health disasters," Reynolds said. "How bad does it need to get before we finally take notice and do something about it?"