Heroin Addiction in Appalachia – The Wrong Type of Opiate Replacement

July 18th, 2014 | By admin | Posted in Blog, Drug Addiction

The Appalachian region of the United States has for the last several years been plagued with a prescription drug addiction crisis. However, as the opioid addiction problem has grown, it has also changed. Today, many residents of Appalachia are becoming addicted to heroin. According to statistics from the Health Statistics Center in the Department of Health and Human Resources, in West Virginia there were 67 heroin overdose deaths in 2012, compared to only 9 deaths in 2001. In Kentucky, the report reveals that heroin overdoses accounted for 129 total drug overdose deaths in 2012, up from 42 the year before.

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Heroin is a drug that is synthesized from morphine, an opioid derived from the poppy plant. Heroin is found either in powder form, which the user snorts, or it can be changed into a clear liquid and injected. Black tar heroin is the name given to the substance when it is in a dark, sticky form that is also injected into the user’s vein. Heroin is extremely addicting, and the government (National Institute on Drug Abuse) estimates that 23% of individuals that use heroin become addicted to it.

History of Heroin Use in Appalachia

The history behind Appalachia’s obsession with drugs is long and varied. The area is stricken with poverty, a factor that commonly leads to drug abuse. The unfortunate results of one survey named Clay County, Kentucky, as the most challenging area of the country in which to live, based on household income, life expectancy, and disability rate. Several other southeastern U.S. counties accompanied Clay County near the bottom, according to the New York Times’ survey, including: Humphreys County, Mississippi; East Carroll Parish, Louisiana; Jefferson County, Georgia; and Lee County, Arkansas. The study points to poverty, as well as the fact that many Appalachian residents are isolated from major highways and cities, as the stem of many of its problems, including the area’s high rates of drug abuse. As residents in some of the poorest and most geographically isolated counties in the country struggle with daily life, chronic pain, depression, mental illness, and poor opportunities, many have turned to prescription painkillers to get through the day. Opiates like prescription painkillers provide physical pain relief and a feeling of euphoria that helps take troubles away for the moment. However, after the high has worn off, users quickly realize that they are still in the same situation they were in before they got high. They are trapped in the drug addiction and cannot stop. Heroin is an easy substitute for those that abuse prescription opioids, which is why it is becoming such a problem in Appalachia. Residents of these states that have been using and abusing prescription painkillers for some time now are quickly turning to heroin. For these residents, heroin is less expensive, it is easier to obtain as the government cracks down on regulating painkiller prescribers, and most users claim it offers a better high. Heroin dealers have found the Appalachian region of the United States to be an easy target. Most heroin coming into the area originates from Mexico; traveling north to cities such as Chicago, Pittsburgh, Philadelphia and Baltimore before arriving in Appalachia. Suppliers know that these residents are willing to pay. West Virginia federal district attorney William Ihlenfeld recently told West Virginia Public Broadcasting’s Ben Adducchio, “They can sell a stamp bag [of heroin] for a lot more in northern West Virginia than they can on the streets in Chicago, or Cleveland. They put that in our marketing plan, and they are very good at what they do. That’s what we are up against.”

Effects of Heroin Abuse

Heroin works by binding to opioid receptors in the brain. These receptors are part of the brain’s reward center, and they regulate the person’s perception of pain. By interacting with opioid receptors, drugs like heroin allow the individual to experience rapid and powerful pain relief, while also experiencing a rush of euphoria: the high that leaves the person wanting more of the drug. As the individual becomes dependent on heroin, they will begin to experience withdrawal symptoms if they stop using. These symptoms can range from uncomfortable to severe, usually characterized by achiness, anxiety, insomnia, stomach cramps, nausea, and vomiting. Heroin addiction leads to a host of problems, one of the worst of which is drug-seeking behavior. Heroin addicts describe themselves as being desperate to find more drugs. This dependence leads people to lie and steal from those closest to them, when they have run out of money and other options for getting their drug. This is the basis for the vicious cycle of heroin addiction. The user feels the high that makes them want more, leading them to lie, steal and cause heartache for their family and friends in order to get more drugs. However, after a short while they feel ashamed for what they have done. This leads to depression and sometimes thoughts of suicide, which the person alleviates by using more drugs, starting the cycle all over again. If the individual would ever say they have had enough and want to quit their heroin abuse, withdrawal symptoms make them regret that decision and quickly return to the addiction. Heroin abuse is a growing problem, not just in Appalachia, but throughout the country and the world. U.S. Attorney General Eric Holder recently called the rising number of heroin overdoses an “urgent public health crisis.” According to the National Institute on Drug Abuse, in 2011, 4.2 million Americans aged 12 or older (or 1.6 percent) had used heroin at least once in their lives, and between 2006 and 2010 the U.S. experienced a 5 percent increase in heroin overdose deaths.

4.2 Million Americans tried heroin in 2011
966 thousand became addicted

Dangerous New Trends in Heroin

State Forensics Lab scientists in Appalachia have noticed dangerous trends recently as heroin becomes more widely used. Much of the heroin being sold today is either being cut with harmful substances, or it is not being mixed with anything, both of which cause increased rates of overdose deaths. Because many of the substances that are commonly cut with heroin can be harmful, such as chalk, brick dust, or talcum powder, users can die from complications caused by these substances. On the other hand, heroin that is purer than the user is used to can easily cause the person to overdose. Overdose is common among heroin users. Heroin overdoses played a role in over 164,000 emergency room visits in 2006 across the United States, according to the CDC. There is an antidote to heroin overdose however, a drug called Naloxone. This opioid antagonist reverses the effects of heroin; in essence saving the overdose victim’s life. In some major cities in America, the drug Naloxone is even being distributed to first responders and to friends and family of heroin addicts, in the hopes that quick-acting individuals might be able to administer the medication and save lives.

Solutions to the Heroin Epidemic

Prescription drug addiction in Appalachia has attracted the country’s attention in recent years, but little has been done yet to curb the problem. Because of the region’s recent switch to heroin, many now believe it is time to do something about this overwhelming issue. Many solutions have been proposed, but the best methods for tackling a societal problem as big as the heroin epidemic include law enforcement and legislation, education and prevention, and most importantly, treatment.

Heroin Abuse Legislation and Law Enforcement

Even before the term “War on Drugs” was in anyone’s vocabulary, methods such as legislation and law enforcement were being implemented to keep drug addiction from taking hold of our country. Over the years, many have grown weary of the less than effective war on drugs, and are looking for other alternatives. However, there are many cases in which it is appropriate for the government to step in and either keep the peace or prosecute those that are using illicit drugs, in order to deter others from starting. The government has focused its energy and resources on fighting the prescription drug problem, including shutting down pill mills and prosecuting doctors that knowingly overprescribe painkillers to drug addicts and dealers. This has been somewhat effective in reaching the number of individuals abusing prescription painkillers, but it has almost singlehandedly created the heroin addiction problem to the extent that we know it today, and now efforts must shift to help those addicted to heroin as well. Other areas of the country are beefing up law enforcement in an effort to catch more individuals that are using heroin. Still others are taking a different approach, by being more lenient on drug addicts that are willing to enter intensive treatment rather than serve time behind bars. Judges are still likely to hand out strict sentences to drug suppliers or friends who stand by and watch someone overdose on heroin without getting help, in the hopes of preventing more senseless deaths.

Heroin Abuse Education and Prevention

Prevention is almost always a useful method for curbing a drug epidemic. It is much more effective to help a person keep from starting to use drugs in the first place than to find them the support and help needed to get clean later. Education goes a long way in preventing drug addiction. Programs that reach young people before they are exposed to drugs give these individuals and communities the power to remain drug-free and develop healthy ways to manage stress and peer pressure. Education and prevention should also carry over to doctors’ offices and hospitals. Physicians need to be more aware of the dangers each patient faces when put on prescription painkillers. Patients need to understand the risks and proper way to take their medicine so as to avoid prescription painkiller addiction and possibly heroin addiction.

Substance Abuse Treatment

Finally, substance abuse treatment is vital for anyone struggling with a heroin addiction. Sometimes the hardest part of recovery is convincing the individual and/or their family that treatment would be beneficial. Many times heroin addiction is considered to be one of the worst kinds of addiction, one that only the most seasoned addicts are capable of. The truth is, however, that many individuals struggle with heroin addiction today, and hiding the problem will not make it go away. We need to be open and honest about communities that are plagued by heroin addiction. Rather than look down on these individuals or sentence them to time behind bars with no treatment, we should encourage participation in an effective rehab program. Drug abuse does not simply happen on its own. Whether it began as a perceived need to self-medicate because of pain or stress, or if it stems from a traumatic experience, or if it has occurred in connection with mental illness, it is important to work through all the underlying issues that contribute to the drug abuse. The right kind of treatment can enable a person to heal all areas of their life, so that they can go on to live a healthy, drug-free life. Treatment for heroin addiction involves intensive therapy and rehab. Group and individual therapy sessions, as well as methods like cognitive behavioral therapy (CBT) and family therapy are often powerful ways to help the individual develop the skills needed to live without heroin.

Therapy Medications

Because heroin addiction is so difficult to overcome, medications are sometimes used to assist with treatment. Buprenorphine, Suboxone and Methadone are medications that help by attaching to the brain’s opioid receptors, reducing drug cravings while eliminating withdrawal symptoms. Naltrexone is a drug that blocks the opioid receptors altogether and keeps the heroin from having an effect on the individual. This long lasting injectable drug is popular because it works even when patients are non-compliant. The problem with some of these maintenance medications is they often simply take the place of heroin, leaving the individual to depend on these medications to get by. Treatment programs that do make use of these medical aids must also help the individual eventually wean off of the maintenance medications. Whether therapy medications are used or not, the best way to overcome a heroin addiction is to go through therapy and counseling that work together to provide structure and motivation to stay sober, while addressing the issues that have contributed to the drug abuse.

Sources
http://www.drugabuse.gov/publications/drugfacts/heroin
http://www.dhhr.wv.gov/bhhf/resources/Documents/2013_State_Profile.pdf
http://wvpublic.org/post/heroin-problems-wva-african-american-history-growing-hops-and-more
http://www.nytimes.com/2014/06/26/upshot/where-are-the-hardest-places-to-live-in-the-us.html?_r=0
http://www.cdc.gov/homeandrecreationalsafety/rxbrief/

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