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Friday, January 10, 2014

Who Are the Scioto County Heroin Addicts?

Who is a heroin addict in Scioto County? I'm sure most residents are pretty certain they can spot an addict. These addicts are assumed to be gaunt, black-eyed, unkempt males who roam the streets like zombies fresh from an open casket -- they are stereotyped as junkies and social deviants with deep character flaws who endanger us all with their lying cheating, and stealing. Many people would prefer to see these perceived "undead creatures" as corpses fit only for disposal as human refuse.

First of all, let me assure you that opiate dependents including heroin users live alongside you. Some of them are struggling with their need for the substance; some are full-blown addicts; and others are recovering from their addictions. Not all are callous and mindless: they include people we love, and people we would never suspect have a drug problem. Heroin addicts include our high school students, our college students, our babies in the womb -- some of the brightest hopes for our future.

Depending upon their resources, more or less is transparent about the drug abuse struggles of local inhabitants. Power, money, and influence cloak the absolute revelation of the wide scope of the effects of drug abuse in Scioto County. Make no mistake drug abuse exists in all professions and in all social strata. Addicts are in positions of authority, in positions of management, and in positions that afford them a veneer of immaculate perception.

Since the classic era of narcotics control (1919-1960), stereotypes of addicts such as those in the first paragraph have been employed not only by the popular press and pulp fiction writers, but also by medical professionals and policy makers. Why do these stereotypes persist? "The stock image of the junkie continues to shape drug policy and to effectively keep drug users on the margins of the health care system." Society desires to label drug offenders as low-class criminals undeserving of sympathy or rehabilitation. In fictional Mayberry, Otis the drunk was laughable and lovingly addictive. In Portsmouth, Jack the junkie is repulsive and incorrigible. 

(Susan L. Speaker. "Creating the American Junkie: Addiction Research in the Classic Era of Narcotic Control." Contemporary Drug Problems, Vol. 30, No. 4. Winter, 2003)

To be honest, we must understand that a stigma has developed concerning heroin addiction. Just consider the absurdity of being able to identify a heroin addict by appearance. If heroin addicts really looked like the old stereotypes, there wouldn't be any left to roam free. They would all be easily identified, stopped, searched, and arrested. The jails would be full, and yet most of those who do not understand the consequences of leaving addicts untreated would be happy to foot the high costs of confining them in prison.

It is a popular myth that a heroin addict can be easily identified at first sight. The common physical stereotype of an addict is a media invention used as an accepted visual aid to inform the viewer of a base character, not an accurate description of a diseased individual. Can one claiming to "know" the look of heroin addiction also easily delineate a heroin addict from a person suffering with mental illness, depression, cancer, liver disease, prescribed medication or just the burden of life itself?

Not even addicts can spot other addicts with a high degree of certainty, though the disease may include some visible signs that indicate the possibility of addiction. For every addict who may show some visible sign of his/her addiction, there are just as many who show no outward sign at all. 

Gnarly, skinny heroin addicts may appear sickly as a secondary effect of the substance they are abusing. But looks can be deceiving -- an emaciated appearance is not necessarily caused by the heroin itself, but more likely by the terrible lifestyle that can go along with it. Young addicts going through their first severe bout of addiction (and struggling to maintain it) do often lose weight, but it's due to not having finances to eat, and not a direct side effect of heroin. Most likely, the more visible physical tolls of addiction take place over a period of time as they relates to increased lethargy and decreased funds.

Serious drug problems by apparently healthy, prosperous individuals often slip under the radar, says John Marsden, a reader in addiction psychology at King's College London. "Wealthy, socially included people will be able to pass unnoticed for longer," says Marsden. "It's not about emaciation and having a needle sticking out of your arm." An individual with financial resources may be able to continue doing heroin while attracting far less attention. Putting food on the table will not be an issue to the addict with means.

As their dependence deepens many heroin addicts do often end up relying on crime to pay for their habit and, as a result, these people become socially isolated. The effect of all this will take its toll on their appearance also.

As their dependence deepens they will often end up relying on crime to pay for their habit and, as a result, become socially isolated. The effect of all this will take its toll on their appearance.
An individual with financial resources, by contrast, may be able to continue while attracting far less attention.
- See more at: their dependence deepens, heroin addicts will often end up relying on crime to pay for their habit and, as a result, become socially isolated.
And, another fact that also dispels the myth of "living skeleton addicts," must be considered. Some addicts, especially long-term users, tend to be overweight and have a bloated, heavy appearance: this weight gain or swelling can be caused by methadone maintenance. 

Heroin addiction doesn’t care about the color of your skin or what kind of car you drive. Statistics from the National Survey of Drug Use taken in 2011, reported that over 4.2 million Americans had tried heroin, representing over 1.3% of the population. From the same survey, roughly 0.2% of all Americans reported to have tried heroin in the past year alone.

That number jumped to 0.7% for Americans between the age of 18-25. Between 1995 and 2002, the number of teenagers in America, aged 12 to 17, who used heroin at some point in their lives increased by 300%. This increase continues in new and young users across the country who are being lured by inexpensive, high-purity heroin that can be sniffed or smoked instead of injected.

In a 2011 survey by the Centers for Disease Control and Prevention, 5.2 percent of Kentucky’s high-schoolers reported using heroin, nearly double the national average. By the time the teens hit their senior year, use had grown to 7.7 percent, nearly 5 points higher than the nation’s average.

Ohio’s numbers for 12th-graders also are troubling: 4.1 percent say they have used the drug, according to the CDC’s Youth Risk Behavior Survey. Overall, 3.1 percent of Ohio students reported using the drug, slightly above the 2.9 percent national average.

 (Terry DeMio. "KY High-schoolers' Heroin Use Double National Average." January 3, 2014)

The University of Michigan’s Monitoring the Future Study showed that 0.9% of 8th graders, 1.1% of 10th graders, and 1% of 12th graders reported using heroin in the past year. Male students (3.8%) were more likely than female students (2.5%) to report lifetime heroin use. 

According to the study released in 2007 by the National Center on Addiction and Substance Abuse (CASA) at Columbia University, the percentage of students who reported using illegal drugs other than marijuana, such as cocaine and heroin, in the past month jumped from 5.4% in 1993 to 8.2% in 2005.  

"The drug problem on American campuses has become so extensive that more and more university police are finding they don't have the manpower to fight it by themselves," says Joseph Califano, founding chairman of the National Center on Addiction and Substance Abuse at Columbia University (CASA). 

But, the spread of dependency across age groups was fairly even -- the most common age demographic to be admitted to rehabs for heroin abuse was between 46-50 years old, representing 16% of all people checked into such facilities. The average age of first heroin use was found to be 23.4 years in 2008.

Although it is difficult to obtain an exact number of heroin users because of the transient nature of this population, several surveys have attempted to provide estimates. A rough estimate of the hardcore addict population in the United States places the number between 750,000 and 1,000,000 users.

The National Institute of Drug Abuse also speculates that roughly 23% of users who have tried the substance eventually develop an addiction.

Demographics show that rehabilitation clients come from all walks of life, from stay-at-home mothers of three, to busy and successful CEO's, to city bus drivers or hard-working farm hands.
Dr. Neil Capretto, an addiction psychiatrist and medical director at Gateway Youth Services in Beaver County, Pennsylvania, and Beaver County Coroner Teri Tatalovich-Rossi said about one-third to one-quarter of the cases that her office is actively investigating are overdoses -- a noticeable increase from years ago. Here is a report on the increase:

"The modern conference room in Gateway's Youth Services Center is a physical testament to the 'epidemic' that Tatalovich-Rossi, Capretto and others are witnessing. The building was constructed within the past 10 years in order to accommodate the growing population of young people with drug and alcohol problems.

"When Capretto began working at Gateway in 1985, the facility had a four-bed detoxification unit, used mostly by patients abusing alcohol. Since then, the unit has grown to 28 beds, 80 percent to 90 percent of which are typically occupied by opioid users, Capretto said.

“'From 1990 to now, we've easily had a 500 percent increase of people in detox for heroin,; he said.
"The faces of those in the beds have changed over time as well.

"What previously was seen as a drug problem affecting inner-city, low-income populations now transcends all demographic and geographic boundaries, according to Capretto.

"Capretto said teens as young as high school -- from even the best families and communities -- now are becoming addicted and are dying from heroin overdoses.

"From 1988 to 1995, the mean age that young people first used heroin dropped from 27.3 to 19.3, according to the Community Epidemiology Work Group, an organization that collects information from major metropolitan areas in the United States.

"Capretto estimates that between 90 percent to 95 percent of the new heroin users nowadays begin abusing prescription opioids, and then move on to heroin because it's cheaper."

(Jenny Wagner. "HEROIN - HIGH & RISING: Abuse, Overdose a Growing Epidemic.", Beaver Pennsylvania. April 14, 2013)

What Do We Know About Heroin Addicts In Scioto County?

First, we know opiate addiction including heroin addiction is recognized as a chronic, relapsing brain disease with a wide range of serious medical consequences. Findings from brain imaging studies in humans, along with basic cellular and behavioral research in animals, have identified profound disruptions in the specific brain circuits and cells that underlie addiction.

We understand heroin “addiction” doesn't occur in everyone, any more than diabetes occurs in everyone who eats too much sugar or food. Many vets of Vietnam who used heroin can surely attest to this fact. And, of course, we naturally assume heroin addiction would never occur when a child is "properly raised" and chaperoned.

We also know, according to the National Survey on Drug Use and Health, as far back as 2003 an estimated 3.7 million people had used heroin at some time in their lives, and over 119,000 of them reported using it within the month preceding the survey. And, we understand that is an underestimate. If true accounting were possible, heroin addiction numbers would be much higher.

In addition, we understand with the shift in heroin abuse patterns comes an even more diverse group of users. In recent years, the availability of higher purity heroin (which is more suitable for inhalation) and the decreases in prices reported in many areas have increased the appeal of heroin for new users who are reluctant to inject. Heroin has also been appearing in more affluent communities. But, many of us are not frightened of rich, high people doing their drugs.

We know professional physicians, nurses, and pharmacists have a substantial rate of chemical dependence. Sadly, these health professionals have an incidence of dependence that is at least as high as the general population. And, dependency and addiction are present in the fields of law, education, and enforcement. Yet, we believe any occurrence of addiction is well monitored in prestigious jobs.

In fact, no professions are immune to the heroin epidemic. Some people we trust are addicted to heroin but lead 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.

Therefore, we know the conception that heroin addicts are nothing but poor, ignorant criminals is wrong. Here is what one director of addiction research says...

"Evolving research is demonstrating that “addicts” (people who are dependent according to DSM criteria) are not bad people who need to get good, crazy people who need to get sane, or stupid people who need education.  Chemically-dependent people have a brain disease that goes beyond their use of drugs."

(Carlton Erickson, Director Addiction Science Research and Education Center. "Exploding Drug Myths." College of Pharmacy, UT Austin. March 15, 2007) 

Heroin addiction in the county is real. It can occur with any involvement in which people can become immersed, and it is identified by human experience, which means that individual and cultural outlooks are crucial to its appearance.

Even our beloved service personnel are affected by heroin abuse. Afghanistan is known to be the major producer of illegal heroin, producing 87% of the world's heroin. It is thought that Afghan opium (from which heroin and other drugs are made) kills 100,000 people annually.

And lastly, we know that heroin addiction is not going away with wishes and hopes. The United States contains 4.6% of the world's population, and it consumes about 80% of the world's opioid supply. We are an addicted nation.

We can ignore the local problem, try to police it, or drastically change our outlook and policies to fight it effectively and reduce its deadly effects. The eradication of the pill mills in Scioto County did not "bring the heroin addiction problem to town" as many claim. The addictive personalities were here when pill mills existed, and they are still here today. People have a disease that needs to be treated with all of our resources. The only thing that has changed for an opiate addict in Scioto County is the preferred brand of fix.

 "Addiction does not discriminate, it cuts across all socioeconomic classes," says Kevin Hill,  addictions psychiatrist in charge of drug abuse treatment at Harvard Medical School's McLean Hospital. "People use according to psycho-social stressers. Celebrities might have slightly different stressers, such as fame, but they use drugs like regular people — they just use better drugs.

"What actors, singers, athletes, even CEOs have that regular people might not have is more access to drugs, more time to indulge, more money to pay for it, and often a horde of enabling hangers-on who are financially dependent on them and thus more motivated to supply substances for them. It adds up to a situation hard to walk away from." 

You may not identify the heroin addict in your midst. Instead, you may recognize him or her in court, in a rehab, in a hospital, or in a casket at the funeral home. Until we open our hearts and minds to the understanding that diseased people need critical assistance, we will continue to foot the tremendous human and financial costs of heroin abuse.

Do you approve the use of Suboxone and Vivitrol to treat addicts? Can these substances be managed properly under a controlled environment? One cannot put a value on one life saved.

I have to question the decision of Judge Marshall to deny a $1 million grant offered to the Scioto County Drug Court from House Bill 59 as a share of $5 million in the state budget. Here was the initial reaction to the offer from the court as reported on December 10:

"Marshall has operated the county's drug court for eight years, without one-cent in funding with one of the lowest rates of recidivism. Now, he is excited about being named one of five drug courts in the state to receive the funding.

"'The ones that are slipping through the cracks are the ones who don't have a medical card or insurance,' Marshall said. 'Second Chance can take a lot of people, but Second Chance is only so big. Some of these people need longer term in-house treatment, which we can't pay for because we have no money, but that (state funding) would be wonderful. In drug court we try to help 25 or 30. Now, we could double it.'"

(Frank Lewis, "Marshall One Step Closer To Drug Court Grant." 
Portsmouth Daily Times. December 10, 2013)

Something changed the mind of the judge because the Scioto County Drug Court didn't accept the grant. Please understand the feelings of those without sufficient funds to afford drug court. I wonder who in town considers the use of Suboxone or Vivitrol as trading one addiction for another drug dependency when a loved one's life is on the line. Thank God no one in a position of power or status in this county has needed something as controversial as these drugs to handle their addiction ... well, they haven't, have they?

The truth is ugly. In this county, it is evident that your life is worth considerably more if you have power, money, and influence. Without the necessary connections or financial resources, your life has a stigma. That stigma relates to the stereotype of the heroin addict I discussed earlier. If you are not privileged and have an addiction when you get arrested, you will serve time without appropriate rehab, and you will acquire a record that will likely prevent you from getting a job after you pay your debt to society. This is a "two strike" guarantee here that produces repeat offenders with lifelong addictions who hate the system.

Drug court only wants to "take a chance" on candidates with funds who appear to be good models for potential success. This attitude boosts the golden statistics of court efficiency while denying much-needed treatment to the poor inmate or to the hardened offender. The distinct air of Charlie Sheenish and Lindsay Lohanism wafts throughout the town. Certain "protected" people commit crimes that go unreported or even unpunished. It may be so everywhere, but here it is "business as usual."

"If it ain't broke, don't fix it" evidently ruled the decision not to take the money. Isn't it about time to break the old idiom and its tired line of reasoning? I recall this skewed thinking is known as the fallacy of complacency. The reason for the mass appeal of this slogan is self evident since never fixing anything translates into not doing any extra work. With limited success, too many easily satisfied managers desire the path of least resistance

And, Lord knows, we have written the  textbook for complacency here in our impoverished county. On this point, the judge and I must certainly agree.

Broken = "no longer in working condition." After all, just because something isn't broken, doesn't mean it doesn't need fixing. To mistake "not broken" for "perfect" is an error in judgment. Consider the same line of reasoning with a slight revision and rewording: "Just because something isn't broken, doesn't mean it can't be improved."

Just because a heroin addict is broken, doesn't mean he or she can't be repaired and improved. I have seen many addicts who have served time, suffered with the disease, and now live a good life day to day with the understanding they must never return to the hell of substance abuse. Clinical experts will testify that some badly damaged addicts can live a fruitful life thanks to Suboxone and Vivitrol. Sure, they can abuse the treatment, and I ask "What treatment cannot be abused?" They can fail even with the aid of the drugs. But, who is willing to judge the quick and the dead?

So many addicts and/or their loved ones have personally told me they lack the funds for rehab. The addicted poor will likely find themselves imprisoned time and again without State support. They will emerge from prison and attempt to begin anew with an indelible stigma that many find impossible to overcome.

Our legal system has stigmatization at its roots: blaming, punishing and making moral judgments instead of providing treatment and other help that would likely change behavior. The open hypocrisy of this lack of care is appalling. To me, it is much more just to condemn the wrongs of the system than to condemn the sin of using heroin.

 “'If it ain't broke, don't fix it' is the slogan of the complacent, 
the arrogant or the scared. 
It's an excuse for inaction, 
a call to non-arms.” 

--Colin Powell
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