Signs of heroin abuse

A gateway drug to illegal drug use is closer to home than many think — it’s in their medicine cabinets.

The increase use of pain medicine is hugely responsible for opening the door for drug users to turn to heroin.

“Marijuana is not the gateway drug,” said Dr. Janice Pringle, associate professor at the University of Pittsburgh. Pringle leads Pitt-Oakland’s Program Evaluation and Research Unit that is part of the university’s School of Pharmacy. Instead, the increased use and availability of prescription opioids are to blame.

According to a report released by the Center for Rural Pennsylvania, the heroin epidemic has grown out of control in Pennsylvania and is no longer a something only seen in inner cities or within certain demographics.

As a result, there are 52,000 people in Pennsylvania that are in treatment for heroin addiction, and another 760,000 addicts that haven’t received treatment. An even more depressing statistic is that 70 percent of Pennsylvanians in prison are suffering from a treatable substance abuse problem.

Passage from Prescription Drugs to Heroin

A gateway drug is a drug that opens the door to the use of other, harder drugs. Gateway drugs are typically inexpensive and readily available.

“We are treating pain more aggressively and pharmacies are developing more opioids,” she said. Opioids are medications that relieve pain. They reduce the intensity of pain signals reaching the brain and affect those brain areas controlling emotion, which diminishes the effects of painful stimulus, according to the National Institute on Drug Abuse. Some common opioids are Vicodin, OxyContin and Percocet.

The availability and profitability make prescription drug use and abuse widespread whether it’s people on the street trying to make a profit or elderly people supplementing their retirement income.

In the end, these drugs trigger touch receptors that users rely on to not feel pain, Pringle said. But, eventually, these users tend to gravitate towards heroin because it is cheaper. People may pay $20 per pill as opposed to $5 for a stamp, which is a bag of heroin which is about the size of a stamp.

And it turns out that heroin is relatively easy to get, too.

“Once you get into the traffic lane, it’s not hard to get,” Pringle said, adding when a person becomes addicted depends on the quality of the heroin.

“The amount and the purity determine when one becomes dependent.”

A person becomes addicted because the heroin affects the receptors in the brain, Pringle said. It gets to the point where a user needs heroin and if they don’t get it, it makes them sick. Therefore, they manage their use of heroin so they do not go through withdrawal.

From Use to Overdose

Those addicted to heroin can’t seem to get high enough. Chasing the high is paramount in their lives. And chasing the high and overdosing are just a shot away.

An overdose is the accidental or intentional use of a drug or medicine in an amount that is higher than normally used. This may lead to serious long-term consequences or death.

“They get high. If it takes so long and they are not getting that high, they take more,” Pringle said. Sometimes this is a result of someone being away from drugs for a while, such as being in jail. They come out of jail and think “they can pick up where they left off.” Their body is no longer used to the higher dosage so they overdose.

Other times, it is the potency of the drug. Each batch has a different potency, leading the user to play a dangerous game of Russian roulette with each injection.

“Some go after that which either creates death or creates a high.”

Obstacles to Recovery

Ensuring drug addicts get the help they need is not a quick fix.

Insurance payments, lengths of stay in rehabilitation facilities and treating addiction like as a disease are just a few of the things needed to be addressed in order to help a rapidly growing segment of the U.S. population.

“I don’t know how many more people need to die before we wake up,” Pringle said. “They know what it takes, the percentage of success with completed treatment, but they are not willing to implement it.”

Pringle’s words echo those in the report “Heroin and Opioid Addiction Treatment and Recovery Services.”

“We face a new and ironic challenge,” said Secretary Gary Tennis of the Pennsylvania Department of Drug and Alcohol Programs. “We know how to cure substance abuse. The new challenge is are we willing to do what it takes to achieve these cures?

“Right now, the answer seems to be we can’t afford it. Name another disease where our response is we can’t afford to treat it. There are very few diseases where we surrender to costs.”

Pringle said rehabilitation can be successful if attention — and money— is for treatment and for the length of time needed.

“The county is no different from hypertension and diabetes when you consider that we are not spending the money for drug and alcohol treatment.”

Now is the time for people to take a stand and speak up so addicts can get the treatment they need for a successful recovery.

“People don’t know that the outcome can be good,” she said. “Addiction is the stepchild of diseases. People are skeptical of treatment.”

More money, case management and creating a better model for treatment is needed.

“We need someone to keep track of it.”

Ninety Days to Success

Heroin may be a one-hit wonder with its addictive nature, but recovery will take longer to achieve.

According to “Heroin and Opioid Addiction Treatment and Recovery Services,” treatment must “focus on what is medically necessary for the individual” and not based on arbitrary protocol.

“It’s not sink or swim,” Pringle said, adding rehabilitation treatment should be a minimum of 90 days. A support system is also needed whether it is to attend meetings for addicts or being a part of a recovery support group.

Likewise, the National Institute of Drug Abuse recommends a minimum of 90 days of care, which is a great increase from the traditional 28- to 30-day inpatient recovery program.

And it may take up to seven attempts before a person can achieve long-term recovery, Pringle said.

“When someone has cancer and the illness comes back after a little treatment, no one says ‘too bad.’ We treat them.”