Saturday, December 1, 2007

Heroin addiction

A man retrieved a package of white powder from his back pocket, removed a small quantity of it with the edge of his pocket knife, placed it on a pocket mirror, and began sniffing it. He had done this many times before in the restroom at his workplace, so he was focused calmly on the drug as it surged through him, bringing him instant relief from pain and anxiety. Moments later, however, he blacked out and tumbled to the bathroom floor.

The overdose didn’t kill him; in fact, it probably saved his life. It forced him to enter into a treatment program for drug addiction. He got clean, got addicted again, got clean, got addicted again, got clean. This man did not grow up in a poor neighborhood where junkies shoot up on the streets and drug dealers kill each other in turf wars. This man came from the suburbs. He went to several of the best colleges in the country, got a high paying job working with computers, got married, had kids. He also joined an ever-expanding list of people who get addicted to heroin.

The great jazz musician Charlie Parker was a heroin addict. So was the blues singer Billie Holiday. Rock stars Janis Joplin and Kurt Cobain were both heroin junkies. Keith Richards, Eric Clapton, Iggy Pop—all at one time were heroin addicts. In 1996, Jonathan Melvoin of the rock band Smashing Pumpkins died from an overdose of heroin. The list of famous junkies is not limited to rock stars; the actor Robert Downey Jr. is currently serving a prison sentence on heroin-related charges, and William Cope Moyers—the son of renowned journalist Bill Moyers—is a recovering heroin addict.

Statistics show that heroin use since 1992 is on the rise in the United States, and many new users between the ages of twelve and seventeen come from the suburbs. In the period between 1980 and 1995, first-time heroin use for this age group increased fourfold. According to Join Together— a drug education organization—the over-all estimated number of heroin users increased from 68,000 in 1993 to 325,000 in 1997. Heroin use by twelfth graders increased by more than 100 percent from 1990 to 1997. The number of heroin-related cases in hospital emergency rooms throughout the nation increased by 64 percent between 1988 and 1994.

There are many theories to explain the rise in heroin use. Some attribute the drastic rise to new forms of heroin consumption: Heroin now comes in forms that can be sniffed or smoked, alternatives to injection that appeal to young people who see them as healthier and safer than injection. However, users who frequently consume the drug using these methods eventually use injection because as they develop a tolerance for the drug, injection gives them a bigger “rush” for their money. The Drug Enforcement Administration (DEA) has another explanation for the increase in heroin use. The DEA claims that “international drug traffickers have made a strategic marketing decision to push heroin as an alternative to cocaine” once cocaine use went down as a result of public information campaigns about its dangers. Richard Lowry, a political reporter for National Review, argues that heroin’s rising popularity is due to the development of “grunge” culture. Since heroin is a drug of “isolation and oblivion,” it appeals to young people eager to rebel against the broken—and increasingly middleclass— families from which they come. Karen Schoemer, reporting for Newsweek, observes that heroin has become high fashion. From musicians to fashion models, the stars that many young people look up to are using the drug. Says model Zoe Fleischauer, “There are a lot of junkies in the [fashion] industry. It’s very hush-hush. . . . They wanted models that looked like junkies. The more skinny . . . you look, the more everybody thinks you’re fabulous.”

Even though current fashion may seem to raise the reputation and alter the method of consumption of heroin, the nature of the drug has not changed over time. According to the National Institute on Drug Abuse, heroin is a highly addictive drug. It is both the most abused and the most rapidly acting of the opiates, a class of drugs that also includes morphine and codeine. Heroin is processed from morphine—the legal drug doctors prescribe to patients in extreme pain—which is derived from the seed pod of certain varieties of poppy plants. It is usually sold as a white or brownish powder or as the black sticky substance known on the streets as “black tar heroin.” (Other street names for heroin are “smack,” “horse,” and “junk.”) Heroin was originally developed in an effort to find drugs that could help people overcome addiction to opiates, but it was quickly discovered that heroin was more addictive than morphine, and the drug was made illegal.

Despite the fact that heroin use has been illegal for decades, the drug today is more fashionable, purer in form, easier to obtain and easier to use than the drug of earlier days. Heroin today still exacts the same high price on the user, however: addiction and its personal and social costs. Even though heroin sold on the streets today is purer than in the past, it can still be cut with poisons such as strychnine that can put users in extreme risk. Overdose presents a persistent danger, and many overdoses result in death. Other health risks associated with heroin use are the contraction of AIDS and Hepatitis B due to the use of unsterilized needles, malnutrition, collapsed veins, bacterial infections, abscesses, infection of the heart lining and valves, arthritis, and rheumatological problems.

Not all of the consequences of heroin abuse are physical in nature. Heroin addiction also exacts a high price on the addict’s family. Parents may feel shocked and betrayed when they discover that a child is addicted to heroin, and many blame themselves. Families can also feel the financial strain of addictive behavior as the addict spends an ever-increasing portion of household money on heroin. Individuals battling heroin addiction can lose their jobs as well, and some turn to crime in order to get money to buy the drug.

In spite of the many individual costs associated with its use, people continue to use heroin for the way it makes them feel. Heroin causes people to feel warm and content, and it relieves stress. The Institute for a Drug-Free Workplace reports that heroin gives the user a short-lived state of euphoria, followed by drowsiness. It slows the heart rate, breathing, and brain activity, and depresses appetite, thirst, reflexes, and sexual desire. It also increases tolerance for pain.

Users must use higher and higher doses of the drug, however, in order to attain the same effect. Eventually, addicts inject the drug not to obain pleasure but to relieve the pain that sets in as the drug wears off. These withdrawal symptoms usually occur four to eight hours after the last dose and include chills, sweating, runny nose, irritability, insomnia, tremors, and body pain.

Treatment for heroin addiction takes many forms, but always requires stopping the use of heroin entirely. Since withdrawal from heroin “cold turkey” entails extreme pain, other treatments have been developed. The latest treatment for heroin addiction—Rapid Opiate Detoxification—allows a physician to anesthetize the addict so that he or she is unconscious during the most painful period of withdrawal. A more traditional approach to the treatment of heroin addiction is to replace the use of heroin with the use of methadone, another opiate, but one which does not have the same dangerous side effects as heroin and allows the user to live a relatively normal life. Most heroin treatment programs treat addiction as a health problem, not a criminal or moral problem; some even call heroin addiction a disease, but that contention is contested by others who see such labels as relieving the addict of responsibility for his or her addiction. Heroin addiction also adds to the tremendous social burden imposed by illicit drug problems in general. Public Health Policy, a public health organization, estimates that in 1989, there were 10,710 deaths directly resulting from drug consumption in the United States. The total costs of illicit drug abuse were estimated to be $66.9 billion in 1991. Some of this cost is incurred due to medical treatment for addiction and physical illness as a result of drug abuse, and to drug education. A larger portion of the expense, however, is borne by law enforcement efforts which include interdiction, policing, judicial proceedings, and finally, incarceration. Public Health Policy claims that there are over 1.6 million people in prison on drug-related charges—many of those incarcerated are heroin addicts—and that the number keeps growing.

Anyone who snorts heroin at work knows firsthand the costs of drug addiction. He or she could face the possibility of prison, loss of family, job, and health; overdose followed by death is a constant threat. Maybe he or she could switch to methadone or get clean—in prison, in a treatment program imposed as an alternative to prison, or possibly without help—and begin living a productive, healthy life. The health and prosperity not just of rock musicians, models, and actors, but of ordinary people depends upon the quality of the discussion about heroin and the drug policies that arise from it.