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Editor Daniel Callahan MSW, CAP
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American Heroin Epidemic

American Heroin Epidemic

The rise of the misuse of opioids, especially heroin, in America has grown to epidemic proportions in the past two decades. In recent years, however, this has also been accompanied by a shift in the ways that policymakers, law enforcement professionals, those in the legal field and even average citizens see the challenges posed by the use of drugs like heroin. It has also raised a very simple question: How did we get here?

The Initial Factors

A confluence of factors created a perfect moment in the history of America for the heroin epidemic to blow up. These factors also created an environment in which many members of society who had developed addiction issues didn’t see themselves as addicts.

First, an aging population has increasingly been in legitimate need of pain management medications as evidenced by the fact that many states have seen heroin use rise to epidemic levels as their populations have gotten older. It’s important to note that those people who became addicted to opioids often graduated from prescription medicines to heroin only after their prescriptions ran out or their doctors cut them off. Second, the pharmaceutical industry went hard after potential customers during the 1990s, a choice they’re now beginning to pay for in the form of lawsuits from states like Florida.

Additionally, the impulse among medical professionals at the time was to trust the drug companies and their research. It was common for pharmaceutical representatives to tell doctors many things that have since been proven false, such as that a commonly prescribed painkiller like OxyContin:

  • Was less likely to promote addiction than its forerunners, Percocet and Vicodin
  • Couldn’t produce the same high as heroin

More disturbingly, there’s evidence that pharmaceutical firms and chain pharmacies turned a blind eye to the excessive availability of their drugs. This was especially the case in states with large aging populations.

For example, one county in Florida, Pasco, has a single Walgreens that had supplied enough opioid prescriptions to give every single person in the county a six-month supply. There’s also evidence that many chain pharmacies shipped billions of doses into the states where the heroin epidemic exploded.

By 2012, it was estimated that 2.1 million Americans were addicted to some type of opioid. Of those, nearly 500,000 were believed to be users of heroin.

A Second Wave

Charts from the mid-2010s indicated that we might have been seeing a crest in the epidemic sometime around 2016. Just as mitigation efforts by the government tried to take hold and pharma firms began behaving more responsibly, though, a new wave of drugs hit the streets.

Fentanyl from China, in particular, began moving along the drug highways of the U.S. The practice of unloading drugs during transshipment in order to pay expenses has led to a slew of overdoses in states like Ohio where the interstate highway system has provided speed and convenience to traffickers. I-70, I-75, and I-80 all across the state, and the I-65 pipeline that moves drugs from the Gulf Coast to the Midwest is also nearby.

The new wave of drugs is being fabricated in conditions that closely replicate the laboratories that fed the first wave. Street-level dealers frequently cut their products with potentially lethal doses of products such as carfentanil, a drug with such a high potency that it has been deployed in aerosolized form by special forces in Russia. Street-level drugs found in this second wave have been so strong that one police officer had to be administered four doses of Narcan after he accidentally brushed his hand against a package after a raid.

Another disturbing trend in heroin use has been a growing habit of inhalation. This seems to be tied to an uptick in cases where major brain damage has occurred. Fortunately for those involved in this type of drug use, treatment is available that can help them avoid these problems and move toward a more healthy future.

The Effects of Heroin

In 2002, deaths from analgesic opioids, or prescription painkillers, had begun to exceed deaths from heroin and cocaine. Deaths from opioids occur because the drug has a multitude of effects on the human body. These include changes in the regulation of a person’s breathing, pulse, and sleep.

The brain naturally produces opiate-type substances, and they serve specific roles in the body. Unfortunately, the introduction of an outside supply can cause the body to reduce its own output. This can lead to massive swings in mood due to the drop that occurs once the body is back on its own.

One study of IV heroin users who died young found that the study group, which had an average age of 26, had brains equivalent in deterioration to what we’d expect from an Alzheimer’s patient. There appeared to be similar protein buildups in their brains, and their nerve cells also showed signs of breaking down.

An especially challenging aspect of the addiction cycle is the way that heroin rewires the brain. Dopamine is a critical receptor in the brain, and it helps us make choices and affects how much we might enjoy:

  • Eating
  • Having sex
  • Engaging in exercise
  • Socializing
  • Playing games
  • Doing work

In short, heroin literally rewires the way a user experiences the joy of life. Not surprisingly, the drug rewires enjoyment to be entirely about the drug itself.

Opioids can also suppress the nerves in the stomach and digestive system. This is why you’ll see TV ads for products that address opioid-related constipation. It’s also why many heroin users often end up looking unhealthily skinny.

Heroin also impacts the respiratory system. It gives rise to slowdowns in breathing, and this is one of the main reasons for overdose deaths. Users also appear to be at heightened risk for blood clots.

If you or a loved one is dealing with a substance use disorder involving heroin, it’s important to remember that help is available. Despite the health problems associated with addiction, recovery is possible with the right support and treatment.

Withdrawal

At the start of a recovery, heroin users will undergo a period of withdrawal. Opioids have a reputation for being nasty drugs when it comes to withdrawal symptoms. Within 12 to 30 hours of the last dose, a person will start craving the drug. They may also begin to feel body aches and anxiety, and some folks have reported literally hurting right down to their bones.

The phrase “kicking the habit” originated among those going through opioid withdrawals as there is a characteristic leg kick that happens when people get off the drug. In most cases, withdrawal does not lead to any risk of mortality, but it can be a rather challenging period. Those who are at risk of withdrawal symptoms can seek the help of qualified professionals who can supervise the withdrawal process and ensure a safe start to recovery.

The Scale of the Epidemic

The speed at which the opioid crisis took off in America is hard to believe. In the state of Indiana, deaths from opioid overdoses and other forms of misuse rose from 0.8 deaths per 100,000 people to more than 12.6 per 100,000 from 1999 to 2016. The national figure is even higher, clocking in at 13.3 opioid-related deaths per 100,000 people in 2016. According to Indiana University researchers, the state lost $1.5 billion per year in total economic production due to opioids, representing almost a half a percent of its entire economy.

Indiana and other states are facing a litany of problems, including:

  • An inability of first responders to keep up with peak overdose periods
  • Lack of sufficient funding for social services to treat the epidemic
  • Declining employability in their populations as employers pass on folks who have had heroin problems
  • Growing morbidity in the general population

According to the same research from Indiana, 11.9 percent of opioid users were classified as unemployed. They are seeking work, but they cannot find it. In fact, 30.6 percent are classified as non-employed. Nationwide in 2017, one out of four job applicants failed at least a single drug test.

An Older Population

As mentioned above, one of the most concerning aspects of the trend in heroin use in America is that it increasingly involves older drug users. We typically think of drug use as youth behavior, and in fact, many young drug users simply age out of the conduct between the ages of 18 and 30. What we’re now seeing are patients who look more like the general population, including:

  • Construction contractors with back injuries
  • Elderly patients who have mobility problems due to deteriorating joints
  • Individuals receiving hospice-level doses for problems like back pain

By some estimates, as many as 100 million Americans suffer from chronic pain. That figure is expected to grow as the population continues to get older.

Especially challenging for doctors in dealing with the opioid epidemic as it strikes this segment of the population is that pain management problems don’t magically disappear just because a person successfully finished rehab. Fortunately, there are alternative pain management options available to those who are in recovery from a substance use disorder. These options include acupuncture, chiropractic manipulation, diet and exercise, physical therapy and stress-reduction techniques such as yoga and meditation.

Society’s Changing Response

One of the most encouraging developments in recent years has been the shift from treating the epidemic as a crime wave toward seeing it as a public health emergency. Many states have now started to implement diversion programs to ensure that first-time, nonviolent offenders can come out of voluntary treatment programs without a criminal record. Police departments and first responders are also increasingly being issued doses of antidotes like Narcan, a drug that causes a person to almost immediately pull out of the high and the dopey behavior associated with opioid use.

There is also a growing focus on ensuring that people who want access to treatment can get it. Immediate voluntary commitment to drug rehab programs is now grounded in many states for the government to look past admissions of guilt in non-violent drug offenses. Good Samaritan laws are also being put in place to ensure that drug users present during overdoses won’t face prosecution if they call for help. This decision is aimed at trying to reduce the number of needless deaths that occur because people are afraid to call 911.

Getting help is now easier than it has ever been. Treatment centers are becoming more common, and counselors are also more likely to be available in underserved communities in rural and urban areas. The police are generally more understanding, and the courts are also increasingly inclined to give the health of a drug user the highest priority. Additionally, medical professionals are increasingly able to spot the signs of trouble and intervene as a person is developing a habit. Moreover, family members are also more likely to understand that this is a health crisis and not a personal failure.

The process of kicking the habit, though, still demands a lot of commitment. With a persistent attitude and an appropriate level of support from friends or family members, however, it is possible to get clean.

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