After the makers of Oxycontin changed their formula, presumably making it harder to abuse, something unforeseen happened: heroin use began to rise amongst white suburbanites. This is a significant shift from the historically urban prevalence of heroin use. It used to be that heroin was the drug of choice for city-dwelling, young, male minorities. However, the current path to heroin use is paved with prescription opioids. The reality is, addiction doesn’t have any real barriers; it has a broad reach and an even broader topography.
When 9,000 patients in treatment centers nationwide were surveyed, its findings showed “90 percent of heroin users were white men and women. Most were relatively young — their average age was 23. And three-quarters said they first started not with heroin but with prescription opioids like OxyContin.”
While RX opioids are still one of the more popular drugs of choice, the shift toward heroin was a direct result of cost and availability. For example, OxyContin can go for $80 a pill on the street, while a bag of heroin might be $10. An addict doesn’t care whether or not the chemical compound is safe or consistent: they care about the high.
In 2007, over 2,000 people died of heroin overdoses, according to the Centers for Disease Control and Prevention. And 200,000 went to ERs after overdosing in 2008.
According to this NY Times article, “from 2007 to 2012, the number of people who reported using heroin in the previous year grew to 669,000 from 373,000,” presenting a substantial increase in heroin use.
Experts are saying that the aggressive prescribing of opioids like OxyContin and Percocet in the last decade is part and parcel to what has caused the increase in heroin use in wealthier areas. These areas have more access to medical care and doctors willing to write prescriptions. As patients become addicted and the prescriptions dry up, addicts are hitting the street. What seems cheaper at first ends up being financially debilitating as the addiction progresses. That $10 bag becomes two bags, then three, then 10, and before you know it, that heroin addiction has bankrupted your family and destroyed your life.
In order to gain control of the increase in heroin use, physicians need to prescribe more cautiously, lessoning the quantity and frequency of prescriptions. And those addicted, be they teens or adults, need to get help and get into treatment. There’s no hope for moderation for an addict – complete abstinence is the only way.
and many are saying there’s a Heroin epidemic, mostly because of the recent celebrity overdoses and increase in heroin deaths across the country. The latest celebrity death of Phillip Seymour Hoffman seemed to really strike a nerve. Is it because he was clean for a long period of time, openly talking about his troubles with addiction? Or is it because he’s someone we as an audience want or need to respect because of his wide range of talent? It’s a loss, a great one, but it is more a reminder of the devastation drug use can cause.
The use of heroin is prime for a death sentence and its inexpensive procurement makes it an easier and more desirable go-to than drugs like Oxycontin, particularly if you are young, desperate, and broke. At the same time, for celebrities like Hoffman or Cory Monteith, familiarity may be the calling card.
According to the National Institute of Drug Abuse (NIDA), “Prescription opioid pain medications such as Oxycontin and Vicodin can have effects similar to heroin when taken in doses or in ways other than prescribed, and they are currently among the most commonly abused drugs in the United States. Research now suggests that abuse of these drugs may open the door to heroin abuse.”
And according to a 2012 Monitoring the Future study (a NIDA funded survey of teens in grades 8, 10, and 12, only 0.05% of 8th graders, 0.6% of 10th graders and 12th graders reported using heroin at least once in the past year. The number of teens using heroin is down significantly to what it was in the 1990s. The main concern now is that teens addicted to prescription opiods like Oxycontin will eventually turn to heroin because of its low cost.
Concerned about your teen or young adult? Here are some signs to look for:
Pupils very small, like pinpoints, even in dim light
Marks on the skin (if heroin is injected vs sniffed)
Talking to someone who has a drug problem isn’t always easy, in fact, it can be down right difficult. You may encounter denial, anger, frustration, sadness, regret, and you may face a litany of excuses. Regardless, encourage your friend or loved one to talk to a counselor or a teacher, or trusted adult. Be kind and encouraging and make sure you are also getting the support you need. Reaching out to a friend or loved one lost in the throes of their addiction can be overwhelming and deeply upsetting. Make sure you also have resources you need to decompress and ground yourself: a therapist, AlAnon, CoDA, or a space or practice that you can lean into to take care of yourself.
can be an important part of a company, school or drug rehabilitation center’s policy. Some parents have even taken it upon themselves to initiate drug testing in their own homes in the interest of keeping their children drug free.
And while most drug testing programs use the urine drug testing method, there are other ways of testing for substance abuse. We will look at the three most common drug testing methods and the advantages and disadvantages of each.
Instant drug tests and lab drug tests
All drug testing falls into one of these two categories.
Instant tests, as the name implies, can be done on the spot and give you instant results in just a few simple steps.
For laboratory testing, you of course have to go to a laboratory where the tests are performed with sophisticated equipment. Samples can be collected either at the laboratory or collected off site and taken to the lab for testing.
Drug testing programs in business or institutional environments will usually include a two step process that includes both instant and laboratory tests. An instant test will be performed initially and if that returns a positive result, a follow up test on the sample will be performed at a laboratory. These lab tests are important because instant test results aren’t admissible in court. If the test result is to be used for a legal matter, such as termination of employment, for example, the sample must be laboratory tested for confirmation purposes.
The obvious advantage of instant drug testing is that it gives you instant results. The instant drug testing kits are also inexpensive compared to booking laboratory time for drug testing. With many kits, it’s also possible to test for multiple drugs at the same time. Some of them can even test for over a dozen drugs that include all the common street drugs, plus prescription drugs.
As for disadvantages, aside from the fact that the results are not admissible in court, another knock on instant drug tests is that they do give the occasional false positive reading. Even worse, they also give the occasional false negative reading.
On the laboratory side, the advantages are that the testing is handled by professionals and the results can be used in court, as they confirm the presence of drugs. The expense, plus the time it takes to get results, which ranges from hours to weeks, are disadvantages to laboratory testing.
By combining instant drug testing and laboratory testing, costs can be kept down by primarily using the instant tests and only sending the samples that give a positive result away for laboratory confirmation.
Different Types of drug testing
Although you may occasionally see blood and sweat referenced in terms of drug testing, and both those bodily fluids can be used, the three most common ways of drug testing are by using samples of urine, saliva or hair.
It is possible to use an instant testing kit when using urine or saliva to drug test. With these kits, you can collect a sample anywhere (you’ll need a private place for urine, obviously) and test the substances right on the spot. Or, you can collect the samples and have them sent away to a laboratory for testing.
Hair testing cannot be done instantly. Hair samples can be collected any place, but the actual testing will have to be done at a laboratory.
As far as the most common way to drug test, urine reigns supreme. It’s used in the majority of employment testing, pre-employment screening, military and sports drug testing.
Depending on the type of drug and other factors like a person’s body composition, urine tests can detect drugs in a person’s system from a few hours after they’ve ingested them until about a week afterward, maybe a bit longer.
The instant urine drug tests require a person to give a sample of a certain size and then seeing how that urine reacts with specific chemicals meant to detect drug metabolites.
Tests come in different formats like testing strips, where you dip the strip into the urine, or testing cassettes where you have to transfer some of the urine onto the cassette. A popular instant urine test for obvious reasons is the all-on-one cups where you get the sample donor to fill a cup and you put a lid on the cup and push a button to enact the test, never needing to actually interact with the liquid.
Laboratory urine tests will involve doing an instant drug test (known as immunoassay tests) and if the results are positive, running a more sophisticated (and expensive) test that usually involve gas chromatography–mass spectrometry or a similar type of test.
Obviously the advantages are that this type of testing can be done quickly and relatively inexpensively, plus, because it’s the most common type of drug testing, most people are familiar with it already.
The disadvantages of urine testing are that the sample collection can’t quite be done anywhere. The collection process is also a bit invasive. In some organizations like the military, sample collection must be watched.
And urine tests can be cheated. Some common forms of cheating include:
swapping in someone else’s clean urine,
drinking excessive amounts of water or other liquids to dilute the sample, and
adding a foreign substance (salt, vinegar, bleach etc.) to the sample.
Fortunately, these types of cheating can be easily thwarted. Temperature strips can detect when urine isn’t body temperature, which a fresh sample would be. Also, observation of the sample collection prevents swapping. Many tests can detect watered down samples and properly trained testing technicians will be able to spot a diluted sample, not to mention that most drugs aren’t water soluble so this won’t help people cheat in a lot of cases anyway. Many modern instant tests are also equipped to detect adulterated samples, as well as the aforementioned properly trained drug testing technicians. Laboratories will have safeguards in place to detect cheating.
Often referred to as oral fluid tests, they involve taking a swab of fluid from the mouth of the sample donor. The results are available instantly and these tests can detect drug use from about an hour after usage to a few days after usage depending on the type of drug.
The relatively short period of detection is one of their disadvantages.
However, a clear advantage is that the collection process for saliva testing can be done anywhere and can be observed without privacy concerns.
As far as cheating, it has been noted that gum and cigarettes can interfere with the results of these tests, so precautions have to be taken to ensure no gum is chewed or cigarettes smoked immediately prior to the test.
Hair testing involves cutting several dozen strands of hair from a person’s head or body and sending them to a laboratory for testing (the sample collection can also be done in some labs). Short hair is perfectly fine to use and, as mentioned, body hair can also be used. And while cutting off a person’s hair is obviously somewhat invasive, the hair is cut from the back of the head from a few different spots so as to not be obvious.
In the lab, the hair will be liquified and then split into its various components to check for drug metabolites. A huge advantage for hair testing is that it can check for drug use as far back as three months prior to the date of the test. And, not only can it detect the type of drug used, but also how frequently it was used.
Another huge advantage is that it is impossible to cheat. The internet is full of “advice” for people on how to cheat a hair drug test, but no shampoo, dye or bleach can change the molecular makeup of the hair, which is what the tests look at.
However, aside from the aforementioned invasiveness, hair testing has other disadvantages. It’s more expensive than either urine or saliva testing, there is no instant option and drug metabolites won’t show up in hair until about a week after usage. So, for example, if a person used cocaine on Tuesday and a hair sample was taken from them the following Thursday, the cocaine usage from two days beforehand would not be detected.
Whether used in a professional environment or in the home, drug testing can help keep employees, students, children, athletes and others free from the harmful effects of drugs. Each has its own advantages and disadvantages and which one is best for any given situation will depend on cost and other factors.
When the manufacturers of OxyContin changed their formula in 2010 to lesson its potential for abuse, I don’t think they intended to drive addicts to use other drugs. Unfortunately, that’s what happened. As a result of OxyContin’s new formula being harder to snort or inject, addicts ultimately flocked to the streets. The unfortunate drug of choice: heroin—because it’s easier to obtain and cheaper than its pharmaceutical counterpart.
Addicts and drug abusers had clearly moved to the streets, the suburbs, and to heroin. They have essentially migrated toward a drug that is easier to inject or snort, much like the old formulation of OxyContin. Dr. Cicero compared drug abuse to a “large balloon.” He explains it thusly, “You press in one area, and the volume doesn’t decrease, it just simply moves to another spot.” This analogy fits well here as we look at the decline in OxyContin use and the increase in heroin use. As Dr. Cicero’s analogy deftly points out, the Oxy problem hasn’t really been solved; it has just been diverted.
While OxyContin is regulated and easily identifiable, heroin is not. In a weird way, you know what you’re getting with Oxy. But let’s be honest, anytime we put something in our arm or in our noses in an effort to alter our mind and body, we are playing the part of lab rat. Heroin is a problem: it’s unpredictable from one source to the next – sometimes it’s nearly pure, increasing one’s potential for an overdose.
The bottom line is the overall increase in opioid use: this is troublesome and growing into an epidemic. While we can treat addicts when they’re ready, how can we prevent addiction or abuse in the first place? Let’s start the conversation before it becomes a problem, taking preventative measures during the early years of our children’s lives: that perfect time when they’re just starting to dip their toes in the burgeoning years of curious adolescence.