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Heroin Hits Home: The Surprising Face of Heroin Use

beth kane davidson heroin facebook chatBeth Kane Davidson

Heroin is a deadly and highly addictive drug that has found a foothold in a surprising new group of users. While the stereotypical heroin addict in the past was urban and poor, today’s addicts are likely to be affluent, privileged, and living in suburbia.

This month, Suburban Hospital’s Director of Addiction Treatment, Beth Kane Davidson, hosted a public discussion on Facebook about what factors have made suburban teens the new face of heroin addiction, and what resources exist for the families and friends of those affected. Questions were submitted by the public via Suburban Hospital’s Facebook page.

Let’s answer some questions about the basic facts of heroin use, for some of the people who may be unfamiliar about this drug and its effects. First, what is heroin?

Heroin was created in 1874 when a scientist modified the morphine molecule that comes from the opium poppy. It turns back into morphine when put into the human body, where it not only is a power blocker of pain, but also gives the user a sense of total euphoria.

What are the signs and symptoms of heroin abuse?

Changes in behavior include deception and lying, increased sleep, hostility, breaking of commitments, and slurred speech. Changes in appearance include significant loss of weight, general unhealthiness, attire that hides arms and legs, pasty skin, and runny nose with no sign of a cold. Changes in interests and performance include falling grades and increased absenteeism at school, loss of interest normal activities, poor concentration, and poor family communication. Changes in social behavior include a shift to a new group of friends who often display some of these same symptoms. Money problems typically mount and stealing money or items that can be sold to support a heroin habit may begin.

Why are we seeing an increase in heroin abuse?

Increasing heroin use is a direct outgrowth of the epidemic levels of prescription drug (opioid) use and addiction. The United States is by far the greatest consumer (85% of the world’s production) of pharmaceutical drugs such as OxyContin and Vicodin, which are designed to have the same effects as naturally occurring opiates (opium and morphine). As the street prices of opioid drugs such as oxycocone, hydrocodone, hydromorphone and oxymorphone increase, users and addicts are turning to the less expensive and more readily available sources of heroin.

Who is the “typical” heroin user these days?

Heroin users today are young, white and suburban. 

Why are more people turning to the use of heroin? Is media representation a possible cause? 

The explosion of heroin use is due to the increasing expense of prescription opioids. These highly addictive pharmaceutical versions of opiates flow from “pill mills,” which are medical sources that prescribe and fill orders for large numbers to pills for people who may be suffering from chronic pain, and from home medicine cabinets into the hands of young people who use or sell the pills.

To combat the effects the growth of heroin abuse/addiction is having on our society, we need to attack it at its source, which is prescription drug abuse; specifically, massive overprescribing of the opioid drugs that lead abusers and addicts into seeking heroin.

What are government, medical /health communities and pharmaceutical companies going to do to fight the effects that it's having on our society?

Among many emerging efforts to combat this epidemic are: expansion of substance abuse treatment tied to Medicaid Expansion, Prescription Drug Monitoring Programs intended to identify individuals who “shop” many doctors for pain killer prescriptions as well as physicians who may be overprescribing these drugs, laws to punish people for doctor shopping, medical provider education laws, ID requirement laws, safe storage education, public education, health care provider education, and fundamental risk factor reduction.

The pharmaceutical industry has voiced its concerns regarding the opioid addiction and overdose epidemic and claims to be working at all levels to educate the public, patients and providers. Meanwhile, it has come under fire for aggressively marketing to physicians and marketing directly to the public to increase demand for pain killing drugs. Many of these issues are being litigated.

How are users weaned off and is going cold turkey recommended?

To get clean from heroin addiction is a difficult and long-term (lifetime) challenge. “Cold Turkey,” which is total abrupt cessation of use and the suffering through the body’s chemical and physiological withdrawal from its dependency on the drug is extremely painful, causes severe physical symptoms and places the individual at great risk for relapse.

A few of the complications of withdrawal are severe agitation, muscle aches, abdominal cramping, vomiting, diarrhea, profuse sweating, chills, body tremors, hallucinations, and thoughts of suicide. Medical detoxification and supportive care are essential for safely discontinuing heroin use. There are many medical (pharmacological) protocols for this process, some of which replace the heroin use with other, less dangerous drugs for a period of time. And there are behavioral therapies to support the individual’s understanding of their addiction and determination to remain clean. For most addicts, a combination of these approaches gives the best chance for return to health and long term abstinence.

Besides the risk of overdose, what are the effects of heroin dependency?

The short- and long-term side effect of heroin dependency are myriad and involve almost all bodily systems and functions, emotional disturbances and loss of mental capacities for concentration. Among these are immune disorders, respiratory illness, depression, skin infection, severe weight loss, depression, poor intellectual performance and coma and death due to overdose.

What signs & symptoms (behaviors) should I look for in family and friends to identify heroin abuse?

Heroin (known on the street by many names including “H” and “smack”) itself may be found in many forms ranging from white to brown powders and sticky black tar. And it may be injected, smoked or snorted.

The signs of use vary based on the form and frequency of use but the most obvious immediate sign of heroin injection is a person suddenly nodding off and breathing slowly. The user might come in and out of awareness of his/her surroundings, have constricted pupils and act weighted down. Users will show problems in making decisions and difficulty thinking clearly or exerting self-control over impulses. Longer term and more gradual signs of use include declining performance in school or attendance, deterioration of personal hygiene, ignoring responsibilities at home, sudden changes in friends and activities, secretive behavior, increased need for money, and wearing clothing that hides injection sites on the arms and legs. Heroin use can lead to decreased awareness of pain, skin that itches or shows signs of infection, constipation and nausea.

Users will most often deny their use, try to hide their symptoms, and may or may not be aware of the effects that use is having on their lives. It is important to be alert to the paraphernalia of heroin use, including lighters and charred or dirty spoons, syringes, pipes, and belts or rubber tubes used to pump up veins for injections.

If you strongly suspect or know that a friend or family member is using heroin, what should you do to intervene? What should a family member do if they are concerned?

The critical thing family members can do is get professional help. Heroin addiction, as with all forms of substance abuse, must be addressed immediately and aggressively. A simple internet search for resources in your community, national organization references and support groups can be very helpful in finding help.

Of course, we at the Suburban Hospital/Johns Hopkins Medicine Addiction Treatment Center can help assess an individual’s situation, offer treatment, and/or provide guidance and referrals to appropriate resources.

What makes them try it in the first place? We know that one dose makes you addicted, so what is so wrong in their lives that they would go down that road? Very sad.

It is sad indeed. In more than 30 years in this field I have watched the age of addiction and especially the age of first use plummet. The sociological issues driving this trend are extremely complex and have received massive amounts of study. In my experience it comes down to the combination of otherwise normal young people struggling with the normal issues of adolescence, whose lives and world-views are complicated by chaos at home, in school, the overwhelming flood of messages to which they are exposed, and social pressures combined with easy access to cheap powerfully addictive substances that, as you rightly said, can trigger full blown addiction with just one or only a few doses.

As I said above, it begins at home. Again, in my experience the major factors in prevention are open, honest, supportive family or role-model relationships, strong behavioral boundaries that are consistently enforced, and anything in which a young person can be involved that builds and maintain healthy self-esteem and an ability to reach out to someone, anyone, if trouble begins.

Why are heroin users at special risk for contracting HIV/AIDS and Hepatitis B and C?

First, I want to say that we need to break the stereotype of the heroin addict. The old view of the “junky” who uses old syringes under filthy conditions is false. Heroin addiction spreads across all socio-economic strata, and is dominated today by people in the suburban middle-class. Still, increased risk of diseases linked to illicit drugs stems mainly sharing contaminated paraphernalia, especially syringes. Further, as addicts seek more and more access to heroin, regardless of their means of use, they are exposed to “people, places and things” where diseases directly linked to abuse are combined with an individual’s deteriorating concerns for his or her health in general, and where symptoms of illness are hidden from families and friends.

Why do we spend most of the budget dollars on treatment and less on prevention and education of our young folks? I mean young middle school and not programs like D.A.R.E. that we know don't work.

There is in fact a massive gap between the available treatment dollars and the actual needs for treatment. Certainly, prevention is the key and even fewer dollars are devoted to prevention and education.The budgeting decisions are ultimately in the hands of government agencies and policy makers at all levels. And there are many programs and strategies that are attacking this problem with some success. For an in-depth review of the vulnerability of adolescents to drug abuse and strategies to address the problem, I suggest you explore the websites of the National Institute on Drug Abuse (www.drugabuse.gov) and the Office of National Drug Control Policy at the Whitehouse (www. whitehouse.gov/ondcp). Among the dozens of associations, organizations and governmental agencies trying to stem the heroin epidemic, I suggest you also look at the National Council on Alcoholism and Drug Dependence website (www.ncadd.org).

Will a young person using heroin be subject to legal consequences such as detention, or is the focus instead on rehabilitation and addressing their physical/psychological problems?

In all instances where young people break the laws regarding use, possession, intent to distribute, and many other potential charges involving illicit drugs, treatment and rehabilitation should be an overriding concern for family, friends and society in general. Sadly, however, the resources and policies vary greatly across the nation and among jurisdictions, and not all young people receive, can afford, or are offered treatment/rehab options as part of resolving illegal behaviors. Convictions for offenses involving heroin and/or opioid drugs, depending on the individual’s age, may remain part of their record for the rest of their lives, regardless of their access to treatment or possible successful rehabilitation.

Besides counseling, are there medications to help a person addicted to heroin?

Yes, to some extent. Drugs such as Suboxone and Methadone may be used to reduce opioid dependence. Suboxone is the newer of these drugs and carries less potential for abuse and is less dangerous in an overdose. There also are many drugs that may be used to help an individual through detoxification and withdrawal. These must only be administered in a properly controlled medical environment. The drug, Naloxone, is used as an emergency measure to counter the potentially deadly effects of an opioid or heroin overdose on the central nervous system, respiratory system and cardiovascular system, all of which can fail due to an overdose. Just last April, the FDA approved a single-dose, auto-injection form of Naloxone called Evzio, which can be used in an emergency at-home by family and friends in life-saving efforts.

About Beth Kane Davidson

Davidson holds a Master's degree in Education, an Advanced Graduate Studies Certificate in Addictions from Johns Hopkins University, and is a certified addiction counselor. She has more than 30 years’ experience in the addiction treatment field and she is recognized throughout the region for her expertise and leadership in this area. Ms. Davidson is often consulted by the media for her expertise and has been interviewed by CNN, WTOP, USA Today and National Public Radio. She is the reviewer for the Parents Guide for the Prevention of Alcohol, Tobacco and Other Drugs. Ms. Davidson currently serves as the Director of the Addiction Treatment Center at Suburban Hospital.

Beth Kane Davidson's office
6001 Montrose Road Suite 200 
Rockville, MD 20852
301-896-2036