The number of fatal heroin overdoses in Jefferson Parish is on track to match or exceed the 66 that occurred in 2013, a year that saw deaths from the drug double as part of a nationwide surge.

And with the parish lacking the capacity to provide the kind of treatment many addicts need, the trend doesn’t seem likely to be reversed anytime soon.

That was the message given to about three dozen public heath officials gathered Wednesday at a forum held by the Jefferson Parish Alliance of Concerned Citizens.

Jefferson Coroner Gerry Cvitanovich said there have been 44 heroin overdoses so far this year, and he and other panelists agreed the spike stems from the explosion in the abuse of prescription pain medication over the last decade.

Historically, the drug epidemic was concentrated in large cities with easy access to the international drug trade. But as opioids like Oxycontin became available at pharmacies throughout the country, addiction blossomed everywhere, fueling demand. And as state legislatures and law enforcement began cracking down on clinics known as “pill mills” and as federal databases make it easier to catch “doctor shoppers” who get prescriptions for drugs from multiple doctors, more addicts are moving from the medicine cabinet to the streets.

“When they get to the position that it’s too expensive … to buy those drugs or get them prescribed to them, they switch to heroin because it’s the next logical progression,” said Donald Petty, a former Drug Enforcement Administration agent now with the Gulf Coast High Intensity Drug Trafficking Area, a federal drug law enforcement program.

It’s a phenomenon Ysonde Hobbs sees in the addicted veterans she works with at the Department of Veterans Affairs.

“When I start to question them, they all seem, without exception, to have started off with a pain issue,” she said.

Veterans of the wars in Iraq and Afghanistan come back with injuries and get put on pain medications, get addicted, get caught “doctor shopping” and then, inevitably, “they seek out what’s on the street,” Hobbs said.

While new drug users have typically started out with drugs like marijuana, Petty said that today about a quarter of first-time drug users are using prescription opioids. And Cvitanovich said prescription drug abusers are 20 times more likely to move on to heroin.

Petty said the number of heroin abusers nationwide went from about 200,000 in 2008 to almost 350,000 in 2012.

Other reasons for the high number of accidental overdoses are the potency of today’s heroin — three to five times higher than 10 years ago — and the nature of the synthetic drugs it’s often cut with.

Cvitanovich said about a half dozen deaths last year in Metairie were due to heroin that had been cut with acetyl fentanyl, a synthetic version of a powerful pain medication that suppresses respiration more than the heroin it’s mixed with.

Compounding the problem is an inadequate capacity to deal with addicts who overdose, when they are most receptive to treatment.

Cvitanovich, who spent 13 years as an emergency room physician before becoming coroner, said that as soon as overdose patients are alert and aware, they are free to leave a hospital and often do. He recalled one who was returned to the hospital dead an hour and a half later.

Dr. Angela Alexander, director of clinic-based services for the Jefferson Parish Human Services Authority, said Jefferson needs more detox beds available at no charge to the patient. She said if private hospitals each kept five beds available it would make a major difference.

As it is, she said, “they go to the ER and they’re out right away and they’re back again. It’s like a revolving door.”

Cvitanovich said a lack of insurance and a lack of free care are among the largest factors contributing to the growing problem.

“It’s shameful, but it’s true,” he said.

James Becnel, program director with the Alliance of Concerned Citizens, said that drug courts, not draconian sentencing measures like ones passed by the Legislature this year, are the way to combat the problem.

“It’s a public health issue, and mandatory minimums won’t help,” he said.

Petty said none of the trends seen by law enforcement suggest the problem will reverse itself in the near term.

“What we find is the whole complexion of the trafficking is changing,” he said. “It is now in suburbia. It is now in the middle class and the upper middle class.”

Cvitanovich said the face of heroin addiction has changed, getting younger, richer, more female and more ethnically diverse.

“It’s an unbelievably potent drug, and it wins,” he said. “It beats love, it beats family and it beats money.”

The only silver lining, he said, is that the shift in the demographics of heroin addiction includes a decrease among teenage users over the last four years.

“Hopefully, the adults learn something form the teens,” he said.

Follow Chad Calder on Twitter, @Chad_Calder.