Drug abuse tends to be somewhat cyclical. It should come as no surprise, then, that street heroin is making a comeback in America. Actually, heroin use never left. It just faded from prominence for a bit with the rapid rise in the use of opioids or painkillers such as OxyContin, Vicodin, Percodan and Percocet. And, make no mistake about it — painkillers are still a huge problem in this country. But the supply is getting harder to come by, and prices are going up — $60-$80 dollars per pill is not unheard of. That’s a lot of green for someone with a nasty pill habit.
What may have started as simple lifting of a few pills from the family medicine cabinet or snagging some from a friend quickly turns into a nearly insatiable demand for more pills and more often consumption. Most painkiller abusers don’t get their supply from a prescription given to them by a doctor. That leaves buying them on the street or conning someone with a legitimate prescription (but who doesn’t use them) to sell them.
How much easier is it to just go straight for the heroin? After all, heroin is always available, if you have the right hook-up. And, trust us, when you’re hooked on heroin, you always know where to get your fix.
And it’s a lot cheaper than Oxy or Vics (Vicodins).
What’s the lure?
It’s hard to believe that anyone would willingly subject themselves to the risks involved with heroin. Yet that’s exactly what’s happening across America, in big cities, small towns and rural environments. Over the past four years, as a matter of fact, heroin use has been steadily climbing.
Law enforcement officials point to the increase in number of arrests, mostly for possession and using the drug. There’s also the alarming number of overdoses coming into hospital emergency rooms that point up the escalation in heroin use.
What’s the lure of heroin that causes seemingly intelligent or otherwise normal people to smoke or inject the drug?
In a word: euphoria. Drug users are always in search of that extraordinary high, the nirvana or bliss that follows consumption or use. Law enforcement officials and emergency room workers alike say that men and women between 18 and 25 who use prescription opiates or methamphetamines are the most vulnerable to switching over to heroin.
Drug use starts out small
Typically, here’s what happens. Heroin users don’t just gravitate toward the hard stuff all at once. They arrive at that drug of choice after moving up the ladder, so to speak, from less potentially lethal substances.
Most begin experimenting with alcohol, followed quickly by marijuana. Pills of various sorts — stimulants, sedatives, and painkillers — may be next on the list, or they may be consumed in conjunction with alcohol and smoking dope.
By far the most widespread experimentation with drugs begins in high school and even junior high. Peer pressure leads to the first sip of alcohol, popping various party pills such as Ecstasy, lacing a joint with PCP or other chemicals, and moving onto other, harder forms of drug use. It’s not always a straight line progression, nor is it necessarily a foregone conclusion, but once young people start using drugs on a regular basis, there’s bound to be problems — in the near term and long-term.
Smoking heroin leads to huge risks
Some heroin users start off by smoking the drug. The high, while soothing, doesn’t seem to have quite the kick after a fairly short period of smoking it. Many users say they ditch smoking heroin and move on to injecting it within a few months of initial use.
Not only is injecting heroin a much more concentrated introduction of the drug into the body, it’s also a potentially lethal practice — in more ways than one.
For one thing, overdose is always a distinct possibility. It’s often hard to gauge how much is too much. Users never know the purity or strength of what they’re buying on the street. What was okay yesterday may be lethal today. Injecting the drug, a user may just fall unconscious with the syringe still in the arm, foaming at the mount and blood running out of the nose. If no one finds the unconscious individual in time, death from overdose is very likely inevitable.
Even if the person is rescued in time to prevent death, there may be serious and long-lasting consequences. Some overdose victims suffer cardiac arrest and/or stroke. Some have permanent vision loss or impairment in mobility — unable to move or difficulty moving a hand, arm, or leg. In addition, cognitive skills may be severely impaired. What used to come naturally now becomes a near impossibility: thinking logically, remembering simple things, making informed choices, being able to speak coherently. Headaches are a constant presence, and overall quality of life suffers immeasurably.
Do these things happen to all heroin users who overdose, or who use the drug for long periods of time? That’s just it. There’s no certainty that any one person will fall victim to such risks, although the likelihood increased with length of time and frequency of use. In other words, you can only dance with the devil so many times before you’re bound to get burned.
Heroin supply triples
According to the U.S. Department of Justice, the supply of heroin coming to the States from Mexico has nearly tripled in the past five years. This not only has caused the availability of heroin here to skyrocket, it has also raised serious concerns over the risks of intravenous use due to the potency of Mexican-produced heroin.
According to the 2009 National Survey on Drug Use and Health (NSDUH), in 2009 there were 180,000 persons age 12 and older who had used heroin for the first time in the past 12 months. This is significantly higher than the 100,000 first-time heroin initiates during the 2002-2008 periods. The average age of first use among those 12-49 was 25.5 years in 2009.
NSDUH statistics on those dependent upon or abusing heroin in 2009 are even more troubling, increasing from 213,000 in 2007 to 399,000 in 2009.
But talk with law enforcement officials and emergency room workers and you’ll see that the NSDUH data is only part of the story. Many people don’t self-report their drug usage, or downplay it significantly. And surveys are just that, extrapolations from a limited audience. The truth is that heroin usage in the U.S. is much higher than reported — and, seemingly gaining in popularity.
Watch for the signs
Parents, friends, school officials, neighbors and concerned others should be on the lookout for signs of heroin use. They’re not always easy to spot, as users are often quite adept at hiding their habit.
- Euphoria — When high on the drug, literally, the heroin user is in a state of pure nirvana. Nothing seems to faze him or her — until the high wears off.
- Drowsiness — Feeling warm and content from using heroin leads to drowsiness. It can also relieve stress by inducing a detachment from pain and any stress-producing activities.
- Nausea and vomiting — These are common side effects, especially when first using the drug.
- Constipation — This is another common side effect users generally experience when beginning heroin use.
- Pinpoint pupils — In reduced lighting situations, when the pupils normally become larger, someone who is using heroin will have pinpoint pupils — pupils that are very small.
- Scabs on arm veins — When someone begins mainlining, or injecting heroin directly into the vein, you may start to see track marks on the arms, later followed by scabs as a result of repeated injections. After a while, users may wear long-sleeve shirts or jackets in an attempt to hide the injection marks.
- Line of track marks — Over a period of months, heroin users who inject the drug will graduate to shooting up at least once per day — as compared with once or twice a week when first beginning heroin use. All that shooting up leaves an inevitable trail of needle marks, track marks, up and down the arm. In fact, you may see a one to three inch trail of scabs over these track marks up and down the arm or leg from the vein.
- Right vs. left-handed injector — Unless the person is ambidextrous (able to use either hand with the same dexterity), the tell-tale line of injection marks will appear opposite the hand used to inject the drug. For example, a right-handed person will generally inject into the left side, while a left-handed person injects on the right side.
- Collapsed veins — After a long period of injecting into the same veins, a condition occurs called collapsed veins. This is also called blow-out veins. The heroin user will switch then to injecting in veins behind the knee or in the back of the hand.
- Physical signs of snorting heroin — Look for signs of a bloody nose, sniffling, and constant sneezing — when not otherwise sick.
At higher doses, heroin produces a sedative effect, with risk of overdose resulting in unconsciousness, coma, and sometimes death due to respiratory failure. If heroin is taken in combination with alcohol and/or other drugs — especially tranquilizers, the risks of overdose increase significantly.
Where to get help
What should you do if you suspect a friend or loved one has a problem with heroin abuse? In no uncertain terms, you should encourage the individual to get help. And help is readily available from a number of sources.
Talk with the family doctor about getting a referral to treatment for heroin abuse. Or get in touch with federal, state or local agencies that can provide direction. There’s an online Treatment Facility Locator maintained by the Substance Abuse and Mental Health Services Administration (SAMHSA) or you can call the toll-free treatment referral helpline at 1-800-662-HELP.
Check out the listing of State Substance Abuse Agencies and find resources and assistance in your state or locale.
County behavioral health organizations may also be able to provide help.
Remember that it’s almost impossible to kick addiction or dependence on heroin alone. And detoxing (coming off the drug) without 24-hour medical supervision is not only difficult, it’s also dangerous. Just coming clean doesn’t solve the problem of dependence. Psychological counseling and learning healthier coping strategies are required in order for the individual to be able to achieve and sustain a drug-free lifestyle. Family support is also crucial, since understanding and encouragement of the loved one who is recovering from heroin abuse or dependence means developing and maintaining a strong support network.
Begin the dialog
What you can do, right now, is to begin to have the dialog that’s necessary to get the ball rolling to be ready for treatment for your loved one. Expect some resistance. The longer he or she has been using heroin, the tougher the job of convincing your loved one that the time is right for coming clean will be.
You may need to stage an intervention. If that’s the case, go for a professional interventionist — and make sure you’re willing to do what it takes to ensure that the home your loved one returns to following treatment is fully supportive of a clean and sober lifestyle. That may mean that family members need to get some form of counseling or family therapy at the same time as the loved one who’s in treatment. At the very least, go to 12 step family groups for the loved ones of addicts. You’ll not only learn a lot, but begin to understand how you can better help your loved one who’s striving to get on the road to recovery.
With street heroin making a comeback in America, it’s time to get more than just peripherally involved. Chances are that you know someone who’s moved from painkiller abuse to heroin use — and without some sort of professional involvement, the future for that person is not a pretty one. While you can’t make someone want to come clean and stay clean, you can become knowledgeable about what it takes and be ready to support the decision to go into treatment.