Heroin abuse used to be considered a rare problem. Over the last five years it has become a major concern, along with the abuse of prescription opioids like Percocet, Norco, oxycodone, hydromorphone and hydrocodone. When prescription drugs are hard to find or to costly, people may turn heroin since it is relatively cheap. Heroin is also becoming cheaper and more pure. It can also be deadly just like prescription opioids.
All narcotics/opioids have beneficial uses for the treatment of pain. They are only one of many tools available to treat painful conditions. All chronic users can become dependent on such medications, meaning that they will have withdrawal symptoms if they suddenly stop their use. Addiction is the use of a substance despite its harm to the person and the inability of the person to stop its use despite knowing the damage the drug is causing.
How Addiction Occurs
Narcotic addiction occurs in many different ways. Often it starts with appropriate medication use and changes to use to get high and numb the brain. Others like getting high off of recreational drugs like marijauna and move from other substances including alcohol and more potent drugs. In the United States, starting in about the late 1980’s, opioids began being pushed for the treatment of pain. Probably over 90% of all opioids used for pain in the world are used in the United States. With the abundance of drugs for pain being used, unused and stolen, supplies have flooded the streets, leading to a massive addiction problem across this country.
Heroin is a potent derivative from the opium plant that gives a person a narcotic type of high. In the 1960’s and before it was crudely derived and not very pure, and was not greatly used. More recently it is much more pure, being manufactured by drug cartels in Mexico, and now it can often be purchased for much cheaper than prescription opioids. As addicts need stronger doses of opioids to get high, they begin to substitute heroin when their drug of choice is not available. Heroin is now being found everywhere in this country, from city to suburb, urban to rural areas.
The newest problem with heroin is that it is being mixed with very potent opioids, especially fentanyl to deliver a stronger high. Unfortunately the mixing of fentanyl may be quite random, and very small amounts are 50 to 100 times more potent than most other opioids. This mixed heroin with fentanyl has now become a deadly problem on the street. If one takes their usual amount of heroin and if it also contains fentanyl, it can cause a lethal overdose. Opioids can be reversed with a drug called naloxone, but only if it is given before the opioids stop a person’s breathing.
The drug addiction crisis with opioids is a multifaceted problem. More money needs to be spent on the treatment of addiction, and managing this as an illness. But to reduce opioids overall, much more money needs to be spent on pain research to better understand all aspects of pain and to develop new and better approaches to managing and curing painful conditions.
Thomas Cohn, MD
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