Halting the heroin scourge

Steve was guest-hosting "The Diane Rehm Show" on NPR recently, and the topic was the nationwide upsurge in heroin addiction. The first caller was Stacy from New Albany, Indiana.

"It's funny," she said. "I'm listening to this show and I have a syringe of heroin in my hand."

She had gotten hurt in the military, explained Stacy, and the painkillers prescribed by her doctors led to her addiction. She uses heroin now because it is far cheaper than the legal drugs that caused her dependency.

"I'm to the point where I don't have insurance. I don't have a home. I don't have a car. I don't have money," she said. "I have a college degree. You know, I'm not stupid. I won a 'soldier of the year' competition twice, and I'm addicted to heroin. So what do I do now?"

A growing number of addicts and their families are asking the same question. The Centers for Disease Control and Prevention reported last month that more than half a million Americans abused heroin in 2013 -- an increase of nearly 150 percent since 2007. Deaths from overdoses have nearly quadrupled since 2002.

Stacy fits the national pattern. Most heroin users, says the CDC, developed their habit by taking prescription pain relievers. The "greatest increases in heroin use" have occurred among groups with historically low rates of heroin abuse: non-Hispanic whites and women.



"I've been working in addiction since 1978," said Beth Kane-Davidson, a therapist in suburban Washington, on NPR. "I've never seen anything like this, where our young people are dying every day from heroin addiction."

Government and public health officials have been woefully unprepared for this onslaught, and one reason is their failure to understand the reach of the epidemic. Heroin is still often viewed as a "junkie drug," says Sgt. Jay Perry of the Virginia State Police. "You know, (people think) it stays in the city and the backstreet alleys, and that's absolutely not the case anymore. ... Any type of folks are using it -- rich kids, poor kids, it just doesn't discriminate at all."

Then there's the way drug addiction is still viewed by many people. They see it as a choice, a condition victims bring on themselves. And that belief undermines the political will to allocate scarce taxpayer dollars to treatment programs.

However, say the experts, there's another way to address addiction: as a chronic disease, like diabetes or emphysema, that requires continuing medical attention.

"It's not about choice," said Dr. Leana Wen, Baltimore's health commissioner, on NPR. "It's critical for us to change that mindset."

Several callers to the Rehm show emphasized this point. Sean from Indianapolis said he has stayed clean for nine years, but it's a constant struggle.

"I still scare myself, because I don't trust myself nine years later," he said. "I know there is that underlying addiction there. So I cannot be around anyone like that. Just hearing the program sends tingles up the back of my spine right now, from the years of addiction ... because it is a disease that is there for a lifetime."

Carolyn from central Pennsylvania called in while driving home from her methadone clinic, which dispenses legal medication to ameliorate the cravings of addiction.

It was "refreshing" to hear a program that wasn't "demonizing the addicts," said Carolyn, who's served jail time in the past. "You don't get shamed for having diabetes. Addiction is also a disease, but it's often not recognized as one."

Beyond the moral argument for helping addicts is a practical one: Untreated addicts burden the entire society.

"The vast majority of property crimes (are) driven by the disease of addiction," said Perry. "They need to get that fix every six or seven hours, and they'll basically do anything to get it."

So what's the answer to Stacy's question? What can she, and the larger society, do about this epidemic?

Dr. Tom Frieden at the CDC proposes tighter controls on how doctors and pharmacists dispense painkillers; greater police efforts to restrict the supply of heroin; and more public funds devoted to treatment programs. The White House recently announced a modest grant program to promote collaboration between public health and law enforcement officials.

All good ideas, but they can only work if addicts cooperate by committing themselves to treatment.

Nancy from Sparta, Illinois, an addict for half of her 60 years, said bluntly: "In the final analysis, the person that's going to help me is me. I can go to all the treatment I want to (but) if I'm not ready to quit, I'm not going to quit."

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