Changing the way we treat heroin and opioid addiction

Most people celebrate their twenty-first birthday by drinking alcohol legally for the first time. For my twenty-first in 1993, I tried heroin for the first time. All it took was a small-scale, but measured, injection, with the assistance of a friend. Only seconds later, both the rate and depth of my respiration sharply decreased. My breathing rate tumbled to about to two to four breaths per minute. As my respiratory rate declined, my blood pressure began to drop, my body temp plummeted, and my skin became cold and clammy. Subsequently, I turned a cadaverous hue of bluish-grey. I had overdosed on heroin. Eventually I came to and was released from the hospital. Within a week, I was again high on marijuana and prescription opioids.

At age 23, my family and friends insisted that I seek some type of treatment. What followed was a four-month stay in treatment, ten months of sobriety and then a three-month relapse. When Hazelden opened in Chicago in 1993, I began to attend twelve-step meetings at their facility, where I was inspired by social workers, counselors and my family, so much so that I decided to attend college and eventually obtained my Master’s degree. Today, I’m the Clinical Director at the Chicago Hazelden facility.

Many of the patients I see have traversed the same path I did. Data from the National Survey on Drug Use and Health (NSDUH) show that nearly one-third of people ages 12 and over who used drugs for the first time began by using a prescription drug for non-medical purposes. The same survey found that over 70-percent of people who abused prescription pain relievers got them from friends or relatives, while approximately only five-percent got them from a drug dealer or from the Internet.

Additionally, the latest Monitoring the Future study, the nation’s largest survey of drug use among young people, showed that prescription drugs are the second most abused category of drugs after marijuana. “Pharm parties,” gatherings of mostly teenagers who arrive with sedatives and opioid pills from their parents’ medicine cabinets or from street dealers, are still widespread.

I was lucky. I didn’t become a heroin-related death statistic. The Centers for Disease Control (CDC) recently released new statistics showing heroin-related deaths in 2012 (the most recent figures) increased in 28 states, including Illinois. At our facility in Chicago, one-third of those admitted for treatment thus far in 2014 are addicted to opiate-based drugs (heroin or various prescription drugs), the highest it’s been in nine years since I’ve worked at Hazelden.

October is Heroin Abuse Awareness month, and “National Drug Take-Back Week” is October 27-November 2. It’s a perfect time to address are three areas of prevention and treatment in a new manner.

Doctors – Physicians, particularly those at hospitals, often over-prescribe painkillers. Doctors need to be better trained and educated about the potential for opioid abuse and addiction. Physicians need to be more aware of how their prescribing practices are contributing to the other serious health care problems.

Parents – Parents need to be more aware of what drugs they have inside their homes. In a survey commissioned earlier this year by the Hazelden Betty Ford Foundation, one in four households reported having painkillers (opioids) in unlocked cabinets or in the open and accessible to their children. These drugs have become the so-called “gateway” drug to heroin use and addiction. Parents need to make sure prescription drugs are locked away out-of-reach of children and young adults, and should safely dispose of unused and expired drugs.

New Approach – We in the addiction treatment profession need to revisit and rethink how we treat people with addiction, providing a more comprehensive approach to treatment. It’s about treating the human being who has a substance use disorder, not treating “an addict.” Programs need to be less rigid and more elastic to blend with the special circumstances of the individual and their families.

Addiction is a very isolating disease. It thrives in secrecy. Reaching out for help is paramount to both the addict and the family. In the media coverage that followed Phillip Seymour Hoffman’s death, the press and public often forgot or didn’t realize he was very sick with a chronic, recurrent but treatable illness. We should take this as an opportunity to have empathy and realize we can intervene to help instead of shaming, blaming or turning away. I feel grateful every day that I am free from the grips of addiction. It’s time we spread the message of hope to others still suffering

Addiction Isn’t A Secret

Addiction is a very isolated disease. It thrives in secrecy. Reaching out for help is key to both the addict and the family. If your drug use as become uncontrollable, reach out for help. YOU CANNOT RECOVER ALONE. Use your supports; call your local treatment center for guidance. No one needs to suffer with addiction alone. In the wake of Phillip Seymour Hoffman’s death, the press and public are casting stones and gaping, but we forget he was very sick with a chronic, recurrent but treatable illness. We should take this as an opportunity to have empathy and realize we can intervene to help instead of shaming, blaming or turning away.

The Heroin Epidemic: It’s Our Problem, Not Their Problem

I have been in the media a lot lately educating the public on addiction and recovery. When Philip Seymour Hoffman died of a heroin overdose, I was called by Don Lemon to speak about my own heroin addiction and recovery on a show called Heroin: 100 years of Seduction. A few months later, I testified on a heroin task force in Illinois and observed first hand the complexity of dealing with such a deep-rooted systemic and biological epidemic. I feel powerless over my own addiction and am beginning to feel powerless of the heroin epidemic. The local government will have hearings and discussions and dictate policy that will hopefully assist communities understand the problem and offer solutions; . The law enforcement will continue to incarcerate the drug smugglers. Unfortunately, it’s not enough. Its time the recovery community mobilizes, and pulls addiction out of the basements and into the open. I am proud to be in recovery. I feel grateful everyday that I am free from the grips of addictive addiction. Its time we spread the message of hope to others still suffering. We need to stop glamorizing addiction and begin celebrating recovery.

Why All the Fuss? Heroin Facts.

Heroin: Invented 1874

Sold by Bayer in 1898: Aspirin was sold by prescription only at this time; heroin was sold over the counter as a cough sedative.

Where does it come from?
Columbia, Mexico, Thailand, Laos, Afghanistan and Pakistan

Columbia became a major contender of the heroin trade in the 1990’s accounting for around 60-70% of heroin.

Pharmacology:
Approx 30-60 seconds after injecting heroin users feel a surge of warmth, emanating from the lower spinal region as a “rush” of sensation glides through the central nervous system. An overriding sense of wellbeing quickly envelops the user. This sense of well-being is the users grail.

Behaviors of the heroin addicted often risk imprisonment, violence, social condemnation, physical disfigurement, disease and death.

Street heroin:
Cut with a number of additives such as quinine, milk sugar, starch, powered milk, and even talcum powder. In 1980 average purity was 4%; now its in the 70’s
Increase in purity can be attributed to greater availability, more sophisticated labs, and marketing techniques by retailers.

Physiological Effects: Occur very rapidly
Affected are:
CNS
Endocrine system
Cardiovascular system
Respiratory system
Gastrointestinal system
Skin

Within seconds, both the rate and depth of respiration sharply decrease. The rate of breathing can fall to 2 to 4 breathes a minute. As respiratory rates decline, blood pressure begins to drop, body temp plummets, skin becomes cold and clammy, eventually turning blue-grey. Seizures may occur and eventually repertory failure occurs. The brain stem drowns in the drug and the message to the diaphragm and lungs to breath drowns with it. Nothing glamorous here…Again, Why all the fuss?