ST. JOHN — The scores of empty shoes on the stage presented a striking image. Each pair represented a life lost to heroin.

While they featured toe tags from actual Wisconsin overdose victims, they could have stood in for the more than 150 Lake County residents who have died from heroin over the past five years.

Overdoses from heroin and opioid painkillers have reached epidemic proportions. Law enforcement struggles to stem the supply. Treatment isn’t adequate to cut the demand. The question then becomes: How do we stop youths from going down the path of addiction in the first place?

That was the focus of a program Tuesday at Lake Central High School called “Stairway to Heroin,” which detailed how and why people descend into opioid abuse.

More than 80 percent of heroin users start with prescription painkillers, said Dr. Tim Westlake, director of the emergency department at Oconomowoc (Wisconsin) Memorial Hospital. And more than half of opioid addicts begin with a prescription from a doctor.

As an emergency room physician, Westlake has been on the front lines of the epidemic.

“It’s far too often I have to have conversations telling parents their children aren’t coming home,” he said. “This stuff’s real and it happens in all our communities.”

Westlake said if there’s one thing people take away from Tuesday’s program, it’s this: A prescription narcotic painkiller is the exact same thing, biologically, as heroin.

So when you leave leftover Vicodins from your surgery in your medicine cabinet, he said, it’s like having a bottle of heroin sitting around the house. And you wouldn’t do that, would you?

Doctors need to prescribe opioid painkillers less, he admitted. But, beyond that, he said, parents should be advocates. Just because a physician prescribes a narcotic to their child doesn’t mean they have to fill it, or get the entire prescription. Nine out of 10 drug users start as teenagers, a time when the brain is more susceptible to addiction.

Westlake pointed to a study, published in the Journal of the American Medical Association, that found that the combination of Tylenol and ibuprofen was more effective for pain relief than prescription opioids, which were historically only used for late-stage cancer patients. That was before government regulators advised doctors to treat pain as the “fifth vital sign” and pharmaceutical companies started aggressively pushing their drugs with dishonest marketing campaigns.

“Don’t use opioids unless the pain is absolutely intolerable,” Westlake said.

Chris Gleason, director of the Rosecrance treatment center in McHenry County, Illinois, said substance abuse can be prevented with something as simple as a conversation. He cited research by the National Center on Addiction and Substance Abuse that concluded that families that have dinner together are 50 percent less likely to have kids who use drugs.

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He also said to be aware of your boundaries with your children.

“I have parents come in saying, ‘I don’t care if my kids drink in the basement,’” he said. “You know where it starts? ... It doesn’t start on the street corner. It starts in the basement.”

Tyler Lybert, of Oconomowoc, Wisconsin, began experimenting with pills at the age of 15. A year later, he was addicted to heroin.

That began a 12-year nightmare that nearly tore his family apart. He stole from them constantly. His older sister moved out of the house. His parents almost divorced because of the strain.

“As long as I was getting high, that was the only thing that was important,” he said Tuesday.

He finally found sobriety eight years ago, after his family kicked him out of the house until he got clean, but not after leaving a path of emotional destruction in his wake.

And that’s the best-case scenario.

The worst case is what happened to Melanie Crandall, a Jefferson, Wisconsin, woman who lost her 17-year-old daughter, Alexis, to a heroin overdose in 2012.

She read a letter Tuesday that she’d penned in the hospital as her daughter took her last breaths. “I can’t, I just can’t say goodbye to you,” she wrote. “Please, Alexis, please, I beg you, wake up.”

Now, Crandall is left to warn other parents about the dangers of addiction.

“As long as I speak her name and share her story she isn’t really gone,” she said.

“I have parents come in saying, ‘I don’t care if my kids drink in the basement.’ You know where (drug use) starts? ... It doesn’t start on the street corner. It starts in the basement.” — Chris Gleason, director of the Rosecrance treatment center

Health Reporter

Giles is the health reporter for The Times, covering the business of health care as well as consumer and public health. He previously wrote about health for the Lawrence (Kansas) Journal-World. He is a graduate of Northern Illinois University.