HOLYOKE - Doctors at Holyoke Medical Center are reporting a "sharp" rise in the number of heroin related admissions to its emergency department.

The overdoses are attributed to the drug's high purity level on the street.

"People are taking their usual amount but then overdosing more," said Finn Scott, director of Holyoke's emergency department.

Scott said hospital clinicians are reporting as many as five opiate-related cases in an afternoon.

"It can be different on different days," he said.

Heroin users during an overdose usually arrive in an emergency room with respiratory problems, sometimes breathing as little as twice a minute.

"After they get their rush, they may pass out for several minutes," Scott said. "If they are not treated, they would die from lack of oxygen."

Holyoke police say the heroin problem is steady and ongoing. But Lt. David Pratt believes the emergency room visits are likely caused by a particular dealer upping the product purity to attract customers.

Holyoke's proximity to New York and Hartford make it a primary location for dealers and users but heroin is a problem statewide, Pratt said.

"It is a devastating drug. People don't realize how addictive it really is," he said.

Both physicians and law enforcement officials say the situation underscores the need for treatment intervention. But funding for such programs through the Department of Public Health has been cut by $11 million since 2001, a problem made more acute by additional cuts to MassHealth, the state's insurance program for the poor. Furthermore, private insurers usually only pay for limited treatment, said Dr. Thomas B. Hewitt, associate medical director at Providence Behavioral Health System's addictive services department.

"There is a medical basis to addiction. It is real and it needs treatment. It is time for private insurance to take care of this like we take care of heart disease and diabetes," he said, adding that we do not stop treating or throw a diabetic off a medical program for "eating a chocolate bar."

But Dr. Marylou Buyse, president of the Massachusetts Association of Health Plans, said private insurers in Massachusetts "generally do a good job at covering treatment and detoxification ... the real issue here is looking at outcomes."

Depending on a program and its level of follow-up care, a short term detoxification program may be more than adequate, she said.

Massachusetts nearly lost its eligibility to keep matching federal drug abuse treatment funds last week after the federal government threatened to withhold money from the state because lawmakers were not, at least, level funding their programs. But the Legislature appropriated about $12 million for substance abuse treatment in a supplemental budget yesterday. The move secured federal funding for now, according to the Department of Public Health.

State Rep. Daniel Keenan, D-Southwick, said past cuts have been a reflection of tough fiscal times, not an unwillingness to fund treatment.

Nevertheless, Western Massachusetts has lost more than half of its detoxification beds due to recent cuts. Presently there are only 60 adult detox beds.

"Admissions to our facilities with clients claiming heroin as their primary drug are just skyrocketing, just about 50 percent say heroin is the primary drug," said Michael Botticelli, assistant commissioner for substance abuse services at the Department of Public Health.

Forty-four percent of treatment admission into department detox beds from Springfield listed heroin as their primary drug "causing them the most problem" in 2003. That number is 56 percent in Holyoke, while the state average for primary heroin treatment admissions was 43 percent last year, the latest figures available from the department.

"Those numbers reflect those lucky enough to get treatment," said Botticelli.

Not surprisingly, Holyoke and Springfield serve as the largest heroin distribution centers in Western Massachusetts and are among the top 9 hubs for heroin in the state, according to the federal Department of Justice.

For that reason, Dr. John Santoro, vice chairman of emergency medicine at Baystate Medical Center in Springfield, is not shocked by emergency visits for heroin here. But he cautions that addicts are at risk even if they do not inject the drug into their veins. Many users try "skin popping," where the drug is just injected into the skin, or snorting, a mode more commonly used by younger users.

The Western Massachusetts share of the state's heroin problem goes beyond addiction, spawning other public health problems including gun violence, doctors said.

HIV rates in Holyoke and Springfield are among the highest in the state, with infections largely being attributed to intravenous drugs use. And Hepatitis C is yet another infectious offshoot, said Hewitt.

"This problem will continue to come back to us. It is horrendous: 80 percent of the people in our methadone program are positive for Hep C," he said, adding that the hospital increased methadone enrollment from 450 to 900 people last year.

Methadone is a drug that dulls the physical effects of opiate withdrawal and is often seen as an effective treatment for heroin addiction.

Both Springfield and Holyoke have also turned down Department of Public Health money to institute a needle exchange which has, in various studies, been shown to reduce transmission of HIV among intravenous drugs users and lead them into treatment.

"Part of this gets politicized," said Botticelli. "If we don't treat addiction, we pay the price for it in other areas, whether that is in other medical complications, unemployment, or an increase in crime. We all pay a price for it."