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Addiction Heroin Opiates Prescription Drugs Substance Abuse

The Suburban Rise of Heroin Use

Heroin use is on the rise.

(Photo credit: Wikipedia)

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.

 

Categories
Addiction Heroin Opiates

OxyContin Use Down, Heroin Use On the Rise

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.

Dr. Theodore Cicero, professor of neuropharmacology in psychiatry at Washington University, and the principal investigator for a three-year research study of OxyContin use noticed a significant drop in OxyContin use after its formula change.  In fact, “Respondents indicating OxyContin as their primary drug of abuse dropped from 35.6 percent at the start of the study to 12.8 percent now.”   Further, the number of subjects who stated they’d used OxyContin to get high at least once in the last 30 days “fell from 47.4 percent to 30 percent.” Unfortunately, the Washington University team found that their respondents’ use of heroin grew from 5 percent to 15 percent—these numbers nearly tripled during that same 30-day period!

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.

Categories
Addiction Opiates

At Death’s Door: An Overdosing “Epidemic”

Image by TerryJohnston via Flickr

According to preliminary data from the U.S. Centers for Disease Control and Prevention(CDC), “Drugs exceeded motor vehicle accidents as a cause of death in 2009, killing at least 37,485 people nationwide.”

What we have is a growing epidemic of pharmaceutical overdoses, where the age of users and overdose victims vary from teens trying to achieve a heroin-like high to adults attempting to manage a slipped disc, or other painful injury. Some of the most commonly abused drugs are OxyContin, Vicodin, Xanax and Soma, but I would be remiss if I didn’t mention Fentanyl, a relative newcomer, but a dangerous one nonetheless. Fentanyl’s allure is its heroin-like high along with its unassuming portability: it comes in the form of lollypops and patches and packs a punch 100 times harder than morphine. It’s drugs like these which are responsible for more deaths than heroin and cocaine combined.

  • Prescription painkiller overdoses killed nearly 15,000 people in the US in 2008. This is more than 3 times the 4,000 people killed by these drugs in 1999.
  • In 2010, about 12 million Americans (age 12 or older) reported nonmedical use of prescription painkillers in the past year.
  • Nearly half a million emergency department visits in 2009 were due to people misusing or abusing prescription painkillers.
  • Enough opiates were prescribed last year to medicate every American adult with a standard pain treatment dose of 5mg of hydrocodone (Vicodin and others) taken every 4 hours for a month.
  • The quantity of prescription painkillers sold to pharmacies, hospitals, and doctors’ offices in 2010 had quadrupled since 1999.

According to a recent CDC report, “3% of physicians accounted for 62% of the OPR (Opiod Pain Relievers) prescribed.” Still, there are many doctors voicing concern about this very issue. There is legitimate concern regarding prescriptions being handed out without sufficient evaluations or follow-ups. We see a lot of this in the often illegitimate pain clinics (pill-mills), who provide easy access to patients and don’t question the potentiality of doctor shopping. Still, it would benefit more physicians to become more judicious with their prescription pads and in the practice of writing a 3-day prescription rather than the ubiquitous 30-day bucket of pain meds, at least for those dealing with acute pain. So far, 48 states have instituted Prescription Drug Management Programs (PDMPs) that will flag doctors who have profiles of heavy prescribing and use. This may some of the problems, but I fear it may also marginalize those who actually need to take pain medications to manage chronic pain issues. According to CDC director Thomas Frieden, they “are still figuring out how to use them (PDMP laws) effectively.” At this point, PDMPs only provide monitoring for physicians and their patients. What they do not monitor is the fact that “seven out of 10 medication abusers get their drugs from friends and family.”

Which brings us to the other issue here, which lies in our homes, hanging out in our medicine cabinets

. Gil Kerlikowske, the director of the White

House Office of National Drug Control Policy says, “As much of 40% of all prescription drugs go unused.” Think that sounds like a lot? Check your medicine cabinets—there’s more than likely something there from some old root canal or surgery you had. As parents, we need to take stock and inventory those medicine cabinets. Safely dispose of what you don’t need and lock up the prescriptions you do need. This not only safeguards our kids, it also eases our own temptation to take an unprescribed medication for our own relief or pleasure. Our kids look to us for guidance. We are their first role models, and if we teach them that medication is their go-to release valve, then the natural byproduct is a lesson in numbing out. Use this as an opportunity to talk to your burgeoning adult about healthier ways in which to manage discomfort. Your kids’ lives are worth it.

Articles linked to and used as reference:

https://www.cdc.gov/Features/VitalSigns/PainkillerOverdoses/

https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm?s_cid=mm6043a4_w

https://www.npr.org/blogs/health/2011/11/01/141914150/cdc-calls-for-action-to-curb-shocking-epidemic-of-narcotics-overdoses?ft=1&f=1001

https://www.pbs.org/newshour/rundown/2011/11/painkiller-epidemic-deepens-in-us.html

Categories
Addiction Opiates Recovery Treatment

Saboxone: A Methadone Alternative?

Recovering from opiate addiction is no walk in the park. With something like heroin, symptoms can occur within 12 hours of the last high, causing addicts several days of sheer misery. Some addicts have no other choice but to detox on their own, suffering the miserable consequences of their addiction. In some ways, if they can make it past that second day, they have a good chance for a successful detox.  Some, however, have the opportunity to go to treatment, which provides addicts the benefit of supportive care and medications to ease the pain and discomfort of withdrawal. A common medication used for this is called Suboxone (bupenophine and noloxone) and purportedly shortens the length of the detox while also treating the withdrawal symptoms. It’s also used for long-term maintenance much like methadone has been used in the past, sans the stigmatization. A prescription for Suboxone means you don’t have to stand in a clinic line for your daily dose, but rather, you get your 30-day rx from a physician.

There are three phases to the using Saboxone in opioid addiction therapy. The induction phase, which is a “medically monitored startup” of the medication, begun 12-24 hours after the addict has abstained from opiates and is in the early stages of withdrawal.  This is typically done under observation in the doctor’s office. Next is the stabilization phase, which happens when the patient has “discontinued or greatly reduced” the use of their drug of abuse and is suffering from little to no cravings. Last is the maintenance phase, which culminates in a “medically supervised withdrawal.”

Nothing is ever that simple, though, when it comes to treating addiction.  While Suboxone certainly has its value for assisting with opiate withdrawal and turning people’s lives around, there is a dark side. It is just another opiate after all.  Some addicts will inject it, some will take more than their prescribed dose, if just for a brief bout of euphoria. Suboxone reportedly has a “ceiling effect,” which means it levels off after a certain amount. Additionally, the naloxone component of the drug is supposed to “precipitate withdrawal symptoms” when the drug is injected. Still, the state of Maine has reported some pretty disturbing news events surrounding Saboxone, with reports of the drug being smuggled into prison, hidden behind postal stamps and kids’ coloring pages. Prison smuggling of this drug is widespread, creating problems from New Mexico to Massachusetts.

Despite the reports of abuse and prison smuggling, the use of Saboxone is still proving to be a promising component to treating opiate addiction. Some experts suggest more training for physicians and tighter regulation of the drug in order to address the rate of abuse. This is definitely something the recovery industry will be paying attention to.

Related articles:

Understanding Drug Addiction Withdrawal (everydayhealth.com)

When Children’s Scribbles Hide a Prison Drug

Getting High on Suboxone? The FDA Says It’s Happening