A gateway drug to illegal drug use is closer to home than many think

(Editor’s note: This is another installment of the series Danni’s Ripple Effect. What follows is an interview with a professor at the University of Pittsburgh who talks about what leads to heroin use and what needs to be done to help those in need.)

By SANDY RHODES

A gateway drug to illegal drug use is closer to home than many think – it’s in their medicine cabinets.

The increased use of pain medicine is hugely responsible for opening the door for drug users to turn to heroin.

“Marijuana is not the gateway drug,” said Dr. Janice Pringle, associate professor at the University of Pittsburgh. Pringle leads Pitt-Oakland’s Program Evaluation and Research Unit that is part of the university’s School of Pharmacy. Instead, the increase use and availability of prescription opioids are to blame.

According to a report released by the Center for Rural Pennsylvania, the heroin epidemic has grown out of control in Pennsylvania and is no longer a something only seen in inner cities or within certain demographics.

As a result, there are 52,000 people in Pennsylvania that are in treatment for heroin addiction, and another 760,000 addicts that haven’t received treatment. An even more depressing statistic is that 70 percent of Pennsylvanians in prison are suffering from a treatable substance abuse problem.

Passage from Prescription Drugs to Heroin

A gateway drug is a drug that opens the door to the use of other, harder drugs. Gateway drugs are typically inexpensive and readily available.

“We are treating pain more aggressively and pharmacies are developing more opioids,” she said. Opioids are medications that relieve pain. They reduce the intensity of pain signals reaching the brain and affect those brain areas controlling emotion, which diminishes the effects of painful stimulus, according to the National Institute on Drug Abuse. Some common opioids are Vicodin, OxyContin and Percocet.

The availability and profitability make prescription drug use and abuse widespread whether it’s people on the street trying to make a profit or elderly people supplementing their retirement income.

In the end, these drugs trigger touch receptor that users rely on to not feel pain, Pringle said. But, eventually, these users tend to gravitate towards heroin because it is cheaper. People may pay $20 per pill as opposed to $5 for a stamp, which is a bag of heroin which is about the size of a stamp.

And it turns out that heroin is relatively easy to get, too.

“Once you get into the traffic lane, it’s not hard to get,” Pringle said, adding when a person becomes addicted depends on the quality of the heroin.

“The amount and the purity determine when one becomes dependent.”

A person becomes addicted because the heroin affects the receptors in the brain, Pringle said. It gets to the point where a user needs heroin and if they don’t get it, it makes them sick. Therefore, they manage their use of heroin so they do not go through withdrawal.

From Use to Overdose

Those addicted to heroin can’t seem to get high enough. Chasing the high is paramount in their lives. And chasing the high and overdosing are just a shot away.

An overdose is the accidental or intentional use of a drug or medicine in an amount that is higher than normally used. This may lead to serious long-term consequences or death.

“They get high. If it takes so long and they are not getting that high, they take more,” Pringle said. Sometimes this is a result of someone being away from drugs for a while, such as being in jail. They come out of jail and think “they can pick up where they left off.” Their body is no longer used to the higher dosage so they overdose.

Other times, it is the potency of the drug. Each batch has a different potency, leading the user to play a dangerous game of Russian roulette with each injection.

“Some go after that which either creates death or creates a high.”

Obstacles to Recovery

Ensuring drug addicts get the help they need is not a quick fix.

Insurance payments, lengths of stay in rehabilitation facilities and treating addiction like as a disease are just a few of the things needed to be addressed in order to help a rapidly growing segment of the U.S. population.

“I don’t know how many more people need to die before we wake up,” Pringle said. “They know what it takes, the percentage of success with completed treatment, but they are not willing to implement it.”

Pringle’s words echo those in the report “Heroin and Opioid Addiction Treatment and Recovery Services.”

“We face a new and ironic challenge,” said Sec. Gary Tennis of the Pa. Department of Drug & Alcohol Programs. “We know how to cure substance abuse. The new challenge is are we willing to do what it takes to achieve these cures?

“Right now, the answer seems to be we can’t afford it. Name another disease where our response is we can’t afford to treat it. There are very few diseases where we surrender to costs.”
Pringle said rehabilitation can be successful if attention – and money - is for treatment and for the length of time needed.

“The county is no different from hypertension and diabetes when you consider that we are not spending the money for drug and alcohol treatment.”

Now is the time for people to take a stand and speak up so addicts can get the treatment they need for a successful recovery.

“People don’t know that the outcome can be good,” she said. “Addiction is the stepchild of diseases. People are skeptical of treatment.”

More money, case management and creating a better model for treatment is needed.
“We need someone to keep track of it.”

Ninety Days to Success

Heroin may be a one-hit wonder with its addictive nature, but recovery will take longer to achieve.

According to “Heroin and Opioid Addiction Treatment and Recovery Services,” treatment must “focus on what is medically necessary for the individual” and not based on arbitrary protocol.
“It’s not sink or swim,” Pringle said, adding rehabilitation treatment should be a minimum of 90 days. A support system is also needed whether it is to attend meetings for addicts or being a part of a recovery support group.

Likewise, the National Institute of Drug Abuse recommends a minimum of 90 days of care, which is a great increase from the traditional 28- to 30-day inpatient recovery program.

And it may take up to seven attempts before a person can achieve long-term recovery, Pringle said.

“When someone has cancer and the illness comes back after a little treatment, no one says ‘too bad.’ We treat them.”

Side

If you think heroin is not a problem in rural Pennsylvania, think again.

“This is the first year ever we had opiates be the drug of choice for our clientele,” said Jessica Dufala, a treatment specialist at Alcohol & Drug Abuse Services Inc.’s Bradford office. “Alcohol has always been the drug of choice.”

Not anymore. Now, people are turning to heroin to achieve a high because it is relatively cheap.
“To continue with prescriptions is very expensive,” she said. “It is so easy to switch to heroin.”
Heroin is in the opiate group of drugs. It is a highly addictive drug and there is significant risk of overdose.

Experts in Pennsylvania agree that services such as this Alcohol & Drug Abuse Services are the way to go.

“Alcohol & Drug Services is the best place to start treatment,” said Dr. Janice L. Pringle, associate professor, pharmacy and therapeutics at the University of Pittsburgh.

But as Dufala pointed out, help is available. Alcohol and Drug Abuse Services offers both outpatient and inpatient therapy. Inpatient therapy is done at Port Allegany’s Maple Manor. The therapy given to the client depends on where they fall on the Pennsylvania Client Placement Treatment spectrum.

As far as starting with prescription drugs, Dufala said that doctors are starting to cut down on prescribing narcotics.

One of the most powerful weapons in the fight against heroin addiction is the use of Suboxone, prescription painkiller used to treat opiate addiction. Another advancement has been the use of Narcan, which if administered quick enough, can reverse an overdose.

Pringle hopes that more emergency agencies and police departments use Narcan. She said the reluctance of some police departments to use it is a perception that there is no chance for the addict to recover. They may also be leery of any liability from using it.

“But they can save a life,” she said.

Dufala said most of the agency’s clientele go to them on the recommendation of the court or referred through county probation. They also have clients who are referred to them by doctors and people are always welcome to call for an appointment.

“If you want to get help, call our office. All it takes is a phone call.”

Generally, people with an addiction problem cannot control their use of the drug – they can’t stop. They also go in a downward spiral, which may include resorting to criminal activity or losing their job.

Alcohol & Drug Abuse Services have offices through the region, but the busiest ones are in Bradford and St. Marys, Dufala said.

But just because someone has become addicted to a drug – whether it is alcohol, prescription drugs or illegal drugs - help is available.

“Knowing there is an option,” Dufala said. Recovery is available to everyone and treatment really is effective.”

Dufala said that insurance companies usually find a way to work with the agency to ensure a client gets the help needed. However, they still take clients regardless of whether they have insurance nor not.

But as Dufala noted, there is no quick fix.

“Nine people out of 10 will probably relapse,” she said. “Heroin has a strong pull.”
Clients sometimes return to their old ways of thinking – that they can’t live without heroin. Generally, the truth comes out from either the client admitting their relapse or a failed random urine test.

But even though relapses occur, they don’t have to.

“A relapse does not have to be a part of recovery,” said Dufala, who has counseled people for a little over two years. “This is an opportunity to change your life.