From the Front Lines: Rx for Heroin Addiction

(David Vittoria is assistant vice president of the South Miami Hospital Addiction Treatment & Recovery Center.)

Eric, a teenager, started taking Oxycontin from his uncle’s medicine cabinet and using it at parties with his friends.

Harold, a 45-year-old father and construction worker, suffers from chronic back pain and was prescribed Percocet by a primary care physician lacking training in pain management.

Both are now heroin addicts. How did this happen?

According to the National Institute on Drug Abuse, nearly half of young people who inject heroin, and were surveyed in three recent studies, reported abusing prescription opioids before starting to use heroin. Meanwhile, heroin has become more readily available to adult users of all ages. The drug has also become more potent and cheaper than ever (more supply than demand).

The convergence of all these factors has created a drug epidemic. More people are dying of drug overdoses than from car accidents or guns. The topic is frequently featured in the news, with recent stories in the New York Times (“Drug Deaths Reach White America”) and 60 Minutes (“Heroin In The Heartland”) and many other media outlets.

Rural communities are in an especially difficult situation with limited access to education, prevention, medical services, and treatment. Larger cities have built solutions into their emergency medical healthcare systems, but also require additional assistance to help curb the problem.

According to the U.S. Centers for Disease Control and Prevention (CDC), unintentional overdoses on Opioid prescription medications, such as Oxycontin and Percocet, quadrupled between 1999 and 2014. There are a number of reasons for this:

1. The increase in use among teens and young adults who aren’t aware of the potential harm of these drugs. Most of these teens get their medications from friends and family. As perception of harm decreases and availability increases, drug use rises.
2. Pharmaceutical companies have flooded the market with these medications through aggressive advertising and marketing to physicians.
3. Physicians are prescribing significantly more Opioid medications. The number has escalated from around 76 million in 1991 to nearly 207 million in 2013.1
4. Many people live with legitimate chronic pain. After taking Opioids for a period of time, tolerances develop. Frequently, patients are getting Opioids from a general physician versus a pain management specialist, who can carefully monitor their dosages. Tolerances to the medication are developed over time and those with a genetic of environmental predisposition to addiction are at an even greater risk.

Heroin Still Readily Available

When users develop a tolerance to Opioid medications and run out of pills, they often go “doctor shopping” to obtain more. This option is increasingly harder to come by. In the 1990s, these individuals would go to pill mills, or store front locations where they could pay a doctor $100 for a prescription. Some people went to these pill mills for themselves, others visited pill mills to sell to others, often to bring across state lines for sale. Ultimately, legislation was passed to shut down pill mills and take away licenses from doctors operating them, thanks to the efforts of many local, regional and statewide organizations.

With no pill mills, what’s next? Now you have hundreds of thousands of people who are sick; they are hooked on opioid prescriptions and experiencing excruciating side effects associated with withdrawal.

Ten years ago, the cost of a one-day supply of heroin would be about $80; today it is $10. So now our friends Eric, Harold and hundreds of thousands of Opioid addicts are sick, don’t have any place to go and many naturally turn to Heroin.

Heroin and Opioid medications have a strikingly similar effect on our bodies. They have the same chemical compound, bind to the same brain receptor sites and have the same impact on our neurobiology. So, opioid abuse is the same as heroin abuse on the brain and the body.

This issue isn’t going away. So what can we do about it?

There Isn’t One Solution

We need a multifaceted approach focusing on the following:

1. Prevention/Intervention Education
   Programs like Lock Your Meds help to educate the general public about their role in preventing prescription drug abuse. We need to let our children know that taking prescription medication is serious business and secure our medication so there’s less availability. Additionally, we need to get information in the hands of people abusing prescription medication or heroin to say “get help.” (Note: unfortunately, treatment isn’t always available, and the more rural the community – the less likely it is.)
2. Training
   First responders need training on administering Naloxone (Narcan), a medication administered intra-nasally that can reverse opioid overdoses within five minutes. Another medicine that can be used is Suboxone. Unlike Narcan, which is used to immediately reduce overdose effects, Suboxone helps relieve withdrawal symptoms and is used when the person isn’t in immediate danger or harm. Sometimes Methodone can be the best medication given to a user who has been using for a very long time, such as decades. For long-time addicts, Suboxone is not always the best solution because they require a much larger dose, which would make them sick. Making these medications available for first-responders is a key component of this strategy.
3. Diversion Programs
   Instead of incarcerating someone in possession of the opioid medication or heroin for personal use, some states are opting not to charge the person and diverting them directly to treatment.
4. Treatment
   Treatment programs across Florida (and the country) need information and awareness about this issue. Many programs don’t currently possess this information and/or don’t properly apply this information to their programs. Successful treatment cannot be accomplished with a “one size fits all” mentality. Programs need to be restructured to deal with Opioid medication and heroin users. Medication Assistance Therapy, for example, can help reduce overdose and relapse rates.
5. Outreach
   By targeting communities, schools, physicians and other community service providers with outreach programs, people can more effectively respond to individuals who are overdosing or experiencing withdrawal symptoms.

In order to keep our children safe, healthy and drug free, all of us need to work together to support these efforts. Whether that means making your children aware of the dangers of prescription drug abuse, securing your medicine, supporting local legislation to help curb the problem, volunteering with local organizations to increase awareness (such as the Ambassador program), or just talking to the people in your life about this issue, we all need to be a part of the solution.