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Thursday, August 30, 2012

Chasing the Smack Dragon

In Ohio, state officials say drug overdoses from heroin increased 25 percent between 2008 and 2009, and are continuing to rise through 2012. Experts say there is no typical heroin user. They come from rich and poor neighborhoods, all levels of education, and can be young, middle-aged or old. And many of those who become addicted die. After all, today’s heroin is said to be as much as 15 times as potent as the heroin of decades past.
“The death certificates don’t tell us how long a person had been using heroin, but given the patterns of opioid use we’re seeing among people in their 40s and 50s, it’s not that surprising that the heroin overdoses are spanning the generations too,’’ said Dr. Wilson Compton, director for Epidemiology, Services and Prevention at the National Institute of Drug Abuse.

Federal risk surveys from 2011 show 2.9 percent of high school students have ever tried heroin, and that more than 350,000 Americans of all ages are addicted to the drug. A national surveillance network of hospital emergency rooms estimates that of nearly a million visits for illicit drug abuse in 2009, more than 219,000 were due to heroin.

Law enforcement and addiction experts say the current surge in heroin deaths reflects both the increased availability of the illicit drug in many U.S. communities and a large population of Americans willing to use it because it is cheaper and often more available than prescription opiates, such as OxyContin, that millions have become dependent upon.

Trying Heroin For the First Time

Reasons for trying heroin are complex and frequently dependent on circumstances relating to the individual and the social environment. There is often a complex interplay between the two. Research shows that as heroin users become more identified with the role of the heroin addict, marked by social marginalization, personal networks of heroin users, and the heroin using lifestyle, they shift to higher risk taking, injecting rather than sniffing the drug. Heroin addiction can become central to the life of people who become addicted, and it typically has a negative impact on other areas of life, such as family, school, work, or recreational activities. (Elizabeth Hartney; "Characteristics of Heroin Addiction"; Guide; July 2 2012)

Heroin can be injected, smoked or sniffed. The first time it is used, the drug creates a sensation of being high. A person can feel extroverted, able to communicate easily with others and may experience a sensation of heightened sexual performance—but not for long.
Some people who are addicted to heroin are able to live a "double life," in which they are able to hold down a job, have a family, and so on. This double life is typically very stressful, and requires an enormous amount of energy and organization, as well as a constant source of money.
Will Taylor, who works as a special agent with the federal Drug Enforcement Administration out of Chicago, says, “The stigma of being a heroin addict is gone. Instead of being cooked or injected, most times it is being smoked or snorted. It could be a 40-year-old mother or the teenager next door who is using heroin.” (Ramelle Bintz; "Why Heroin? A Federal Agent Offers an Overview of the Opiate Trade"; Green Bay Press Gazette; August 3 2012)
People in their teens and early 20s are being targeted as the next big market for a drug that has long been in decline among adult populations. In some places, teens report that heroin is even more accessible than marijuana, ecstasy and alcohol. Since fewer adults are using heroin, sellers are targeting teenagers, who are less likely to have negative associations with the drug.
Taylor contends, “It’s all about money. Bang for the buck? A hit of heroin in Chicago is $10 to $20. A pill could be $15 to $30 per pill, but an addict is using many pills per day and using more to get the desired effect. Theoretically, even if they are shopping insurance and going through a doctor, they are getting high substantially less. Heroin is much stronger — it takes hold very quickly.”
A study (2005) attempts to explain why people use heroin, what leads them to try it, and paints a picture of a suburban Chicago heroin users. The findings in the “Understanding Suburban Heroin Use” study — believed to be the first of its kind in the country — were presented during a community forum in Downers Grove hosted by the Robert Crown Center for Health Education’s Reed Hruby Heroin Prevention Project. (Hamish Warburton, Paul J. Turnbull, and Mike Hough; “User Perceptions of Occasional and Controlled Heroin Use”; Joseph Roundtree Foundation; December 2005)
The 10-month study of suburban students, parents and heroin users concluded the following:

* Many people, including teenagers, no longer associate heroin with the horror stories of overdose and crippling addiction.

* Most people have little knowledge about heroin when they first use it.
* Younger people are getting involved with heroin. Some are getting involved with heroin as a first choice drug.

* One-third of those surveyed starting using it after being addicted to or misusing prescription pain pills such as OxyContin or Vicodin.

* The study also found that more than 75 percent of respondents had a concurrent mental health condition, such as depression, ADHD or bipolar disorder, and used heroin to self-medicate.

* Two-thirds of those surveyed displayed “sensation-seeking behaviors,” which researchers translated to mean they got a thrill out of driving to the West Side of Chicago to buy heroin without getting caught.

* The study also found that the suburban heroin user is white, and the average age of first use is 18. Suburban youth from middle-class backgrounds are much more likely to have access to gateway prescription painkillers. and they also have more money to spend. Many of them have cars, which gives them a greater amount of freedom and mobility.

Add to these characteristics found by Hamish Warburton, Paul J Turnbull and Mike Hough of the Joseph Roundtree Foundation ("User Perceptions of Occasional and Controlled Heroin Use," December 16 2005)

* Few people had their first experience of drugs with heroin. Most had experience of at least one other drug, mainly cannabis, before trying heroin. Many respondents reported having moderate or extensive experience of other drugs before trying heroin.

* Nearly all respondents reported trying heroin because they chose to, not because they felt pressured or coerced into it.

* The process of “peer preference” – the gravitation towards like-minded people – provided a useful framework for understanding why people tried heroin. Most reported trying the drug out of curiosity, although the first experience for a few was prompted by instrumental as opposed to hedonistic purposes – for example, to ease the “comedown” from other drugs.

* A small number also described how trying heroin corresponded with, or was related to, a critical moment in their lives.

What did the research participants have to say?

“I was not a big risk taker as a kid. They can’t picture me using heroin. My mom was putting ribbons in my hair in fifth grade and curling my hair.”

“In junior high I always wanted to be popular. I was a cheerleader and I had friends and I always wanted to be accepted and I kinda wasn’t.”

“Heroin made me feel real mellow like I had not a care in the world. I had a lot of ‘what am I doing with my life’ and physical pain that I was covering up.”

“When I was 12, my mom had 3 bottles of pain pills left over and I took them all. I took them while I was drinking because that is what my sister’s friend told me to do.”

“I thought I was smart enough that I was not going to let myself become ‘that guy.’ I was just going to try it and then walk away. It" doesn’t matter if you are a boy or girl, short or tall, black or white. Your chances of just walking away – it’s not going to work.”

“I didn’t use heroin first – I broke my foot and I was out of pain in like 2 weeks, but he (the doctor) kept me on Vicodin for 8 months. I kept calling for refills and he kept giving them to me. I didn’t know it was addicting. I figured it was safe because it was from a doctor and he kept giving it to me.”

The Brain and Heroin?
(Avram Goldstein, M.D., Professor Emeritus of Pharmacology Stanford University; “Neurobiology of Heroin Addiction and of Methadone Treatment”; April 2012)
People argue that becoming addicted to heroin is a psychological, not a biological problem. But behavior, the business of psychology, is also the business of the brain. Until recently, there had been no way to map the living functioning human brain; but now imaging techniques, such as magnetic resonance imaging (MRI) and positron emission tomography (PET) have begun to make that possible.
Thus, we are actually learning, by imaging techniques,
which brain circuits mediate which behaviors.

All of brain anatomy and chemistry is determined, at the outset, by the blueprints in our DNA. Then, through our life experiences, both anatomy (the brain circuitry) and chemistry (the neurotransmitters and their receptors) become modified.
Most behaviors are determined by both genetics and environment, one or the other predominating in a particular case.

More research is needed to find out if genetic predisposition plays a role in heroin addiction. This is an important issue because if it is true that becoming an addict is not entirely a free choice, but rather is driven by a disorder of brain chemistry, it would validate the disease concept of heroin addiction. And that, in turn, would go far toward removing stigma and legitimizing long-term treatment with an opiate like methadone or LAAM in the eyes of the policy makers, the public, and the addicts themselves.
(“Research Sheds New Light on Heroin Addiction”; Howard Florey Institute; Psychology and Sociology; e! Science News; May 14 2008)
Researchers from the Howard Florey Institute in Melbourne have identified a factor that may contribute towards the development of heroin addiction by manipulating the adenosine A2A receptor, which plays a major role in the brain’s “reward pathway.” Using mice specifically bred without the adenosine A2A receptor, Professor Andrew Lawrence and his team showed that these mice had a reduced desire to self-administer morphine; heroin is converted to morphine in the body. The mice also self-administered less morphine compared to control litter mates, but did not develop tolerance to specific behavioral effects of morphine.

The researchers also found that the mice did not develop a conditioned place preference for the drug, indicating that drug-context associations are mediated in part by this receptor.

In human terms, this equates to the associative memory
of the environment where the drug is used.

Collectively, these findings strongly suggest that the adenosine A2A receptor is involved in regulating the reinforcing and motivational properties of opiates. Professor Lawrence said this was the first study to show that the adenosine A2A receptor was implicated in self-motivation to take opiates such as heroin.

“This receptor clearly plays a major role in opiate use and therefore abuse, as the mice were simply not interested in taking morphine despite it being freely available,” he said. “Although the drug-taking effects and behaviors of these mice were diminished, they still relapsed into drug-seeking after a period of withdrawal. “This indicates that the adenosine A2A receptor has a role in the ‘getting high’ aspects of addiction, but not in the adaptations that contribute to relapse after going ‘cold turkey.’”

“The results from this study reinforce that addiction is a highly complex brain disorder that will require a multi-pronged approach to treat."

Prof Lawrence said that drugs affecting the adenosine A2A receptor show preclinical promise to treat alcohol addiction. “Earlier this year we found that the adenosine A2A receptor interacts with the mGlu5 glutamate receptor found in the brain’s reward pathway to regulate drug-seeking. “Consequently, a drug developed to target both these receptors could have an even better result in treating addiction,” he added.

The Bottom Line

With the heroin of today, people must rethink their approach to this problem. Since the drug is much stronger now than decade ago, prevention strategies must include accurate, timely information about the deadly dangers of the drug. More and more young people are choosing heroin with very little knowledge of its lasting effects.

Once heroin frightened people. More recently, some people have tried to make heroin use “fashionable.” In the past decade, the “heroin addict look”—blank expression, waxy complexion, dark circles under the eyes, sunken cheeks, excessive thinness, greasy hair—was promoted in popular magazines and fashion circles as “chic.”
The effects on the body from continued use of this drug are very destructive. Frequent injections can cause collapsed veins and can lead to infections of the blood vessels and heart valves. Tuberculosis can result from the general poor condition of the body. Arthritis is another long-term result of heroin addiction.

The addict lifestyle—where heroin users often share their needles—leads to AIDS and other contagious infections. It is estimated that of the 35,000 new hepatitis C2 (liver disease) infections each year in the United States, over 70% are from drug users who use needles.
A highly addictive drug known as “cheese heroin” is a blend of black tar Mexican heroin (called “black tar” because of its color) and over-the-counter cold medication, such as Tylenol PM. The drug costs only a couple of dollars a hit and children as young as 9, hooked on cheese heroin, have been rushed to hospital emergency rooms for heroin withdrawal.
The combination of the two drugs can cause vital body functions such as breathing and heartbeat to slow down and result in death. Since 2004, cheese heroin is responsible for at least forty deaths in the North Texas region, according to local authorities.
“When you first shoot up, you will most likely puke and feel repelled, but soon you’ll try it again. It will cling to you like an obsessed lover. The rush of the hit and the way you’ll want more, as if you were being deprived of air—that’s how it will trap you.” -Sam
“Your whole day is spent finding or taking drugs. You get high all afternoon. At night, you put yourself to sleep with heroin. And you live only for that. You are in a prison. You beat your head against a wall, nonstop, but you don’t get anywhere. In the end, your prison becomes your tomb.” --Sabrina


“Heroin cut me off from the rest of the world. My parents kicked me out. My friends and my brothers didn’t want to see me anymore. I was all alone.” -Suzanne
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