Heroin Laced With Fentanyl

Heroin laced with FentanylWhile heroin is a commonly known drug, you might’ve heard lately about heroin laced with Fentanyl, yet not know much or anything about Fentanyl. Here is a description:

Fentanyl is a synthetic opioid, meaning it is made in a laboratory but acts on the same receptors in the brain that painkillers, like oxycodone or morphine, and heroin, do. Fentanyl, however, is far more powerful. It’s 50-100 times stronger than heroin or morphine, meaning even a small dosage can be deadly.

Fentanyl can be produced in illegal laboratories, which means, for the foreseeable future, availability won’t decrease through government regulation. This synthetic opioid is very, very powerful, so it makes a dangerous drug like heroin much more dangerous and deadly. It only takes a small amount of Fentanyl to increase the effects of heroin and cause overdose. Even scarier, some drug dealers are selling a combination of heroin, Fentanyl and cocaine.

Those who buy heroin on the street and start using heroin laced with Fentanyl are at a much higher risk of overdose and death — the drug user becomes dependent on how much Fentanyl is used, their tolerance and other physical factors that in combination can create overdose. It sounds perverted, but a drug dealer might increase business if someone overdoses and dies from heroin laced with Fentanyl, because, on the street, the word of a powerful heroin/Fentanyl mix will likely create a buzz of interest as users seek greater highs. In the experienced user’s mind, they’ll think they can handle the more powerful mixture and that those who died were neophytes.

As congress begins decreasing the amounts of opioids doctors can prescribe, a certain number of patients who’ve become addicted to opioids, but need the drug for management of chronic pain, will seek drugs from alternative sources – if they begin buying synthetic opioids on the black market, this will increase the number of deaths, not lower the number of deaths. I don’t think drug addiction will respond to regulation — it can be treated, though. Heroin laced with Fentanyl is nothing to play with. The entire opiate/opioid addiction epidemic will only get worse until society decides to take action to find fundamental solutions.

Opiates and Politics

Opiates and politicsIn the last decade opiate use has risen significantly. Overdoses and deaths from opiate use are increasing at a frightening rate. Whether it’s opiates like heroin or morphine or synthetic opioids like Percocet or Oxycodone, there’s no difference when considering the consequences of addiction and misuse and possible solutions. When a person develops tolerance and addiction, the body doesn’t know the difference from heroin bought off the street or Oxycodone that comes from a pharmacy.

I’ll just use the term opiate for the sake of simplicity. Opiates like heroin and morphine are nothing new. This is from Wikipedia:

The Mediterranean region contains the earliest archeological evidence of human use; the oldest known seeds date back to more than 5000 BCE in the Neolithic age[8] with purposes such as food, anaesthetics, and ritual. Evidence from ancient Greece indicate that opium was consumed in several ways, including inhalation of vapors, suppositories, medical poultices, and as a combination with hemlock for suicide.[9] The Sumerian, Assyrian, Egyptian, Indian, Minoan, Greek, Roman, Persian and Arab Empires all made widespread use of opium, which was the most potent form of pain relief then available, allowing ancient surgeons to perform prolonged surgical procedures.[citation needed] Opium is mentioned in the most important medical texts of the ancient world, including the Ebers Papyrus and the writings of Dioscorides, Galen, and Avicenna. Widespread medical use of unprocessed opium continued through the American Civil War before giving way to morphine and its successors, which could be injected at a precisely controlled dosage.

Countries like China have had wars over opium, and the U.S. declared a War on Drugs in the 60s, when opiates were referred to mostly as narcotics. Opiate and politics are a big concern now, although the mindset of making war against opiates still prevails. All attempts to eradicate opiates have failed. Just recently government ordered a reduction in the production of synthetic opioids. Government, to its favor, has also called for treatment of opiate addiction, and government supports the use of Buprenorphine as a regulated replacement drug that allows addicts to get into treatment without overwhelming withdrawal symptoms — however, treatment resources and access to resources are sadly insufficient.

Our society seems to favor  symptomatic law and order solutions over long term, fundamental solutions like education, prevention,  treatment and ongoing support. Waging war against drugs has created drug cartels and deadly battles for domination. Addiction, drug misuse and the demand for illicit drugs are the fundamental problems. All efforts so far to change minds and hearts about drug use have come up short. As a society we’re confused about drugs. Thinking clearly and objectively about drugs would be a great first step. If we can remove the fear and stigma, maybe we’ll find fundamental solutions.

If all the resources wasted on waging war against drugs were channeled into education, prevention, treatment and ongoing support, we’d gradually experience a change. Fearing drugs and fighting drugs with weapons have not changed our relationship with drugs. I know it’s a huge problem with no easy solutions, but I have to believe that understanding the problem through real, comprehensive education and prevention efforts will lead us in the right direction.

Treating Heroin Addiction

ndc-logoThe good news in the midst of the heroin epidemic is that treating heroin addiction is possible and recovery is likely if a comprehensive treatment plan is followed long term. There are many recovering heroin addicts in Narcotics Anonymous who’ve been drug free for decades. NA is not the only way to maintain long term recovery, but it’s one of the best, proven ways. Treatment of heroin addiction has a long history as we’ve found our way to where we are today.

One of the earliest attempts at heroin treatment was in 1935 at the Public Health Service Narcotic Hospital in Lexington, Kentucky. This facility was a combination of hospital, farm and prison. The recovering doctor who started an inpatient treatment facility that I worked at in 80s had gone through this treatment decades before when he was legally forced into treatment. This early treatment model tried to modify the patient/prisoner’s behavior. The idea was to instill a sense of responsibility and values through hard work and the isolation of a prison. The problem with this idea is that the doctor I referenced above had these qualities instilled in him from his childhood and medical training and became addicted to narcotics anyway. The doctor addict did not lack a good work ethic. I’m sure working on a farm helped his gigantic ego, but this wasn’t the cure for addiction. The treatment also proved ineffective for tough street addicts from the inner cities — they didn’t respond too well to milking cows and slopping the hogs.

The early failures hardened ideas that heroin addicts and alcoholics and such were incorrigible — they were irresponsible thrill seekers — they were mentally ill — they just wanted to escape — on and on. Synanon was one of these failures — at first, Synanon was based on Alcoholics Anonymous, but it took an ugly turn toward aversion therapy, shaming the addicts, shaving their heads and making them carry around disparaging signs, and really crazy stuff. Eventual discoveries in neurobiology regarding addiction changed the nature of treatment, although old ideas still abound that aversion therapy or religious conversion or jail time or talking therapy, etc, will resolve the problem. The better understanding of addiction created the Hazelden/Minnesota model of basically 28 day inpatient treatment based on addiction as a disease. Heroin treatment mainly went the way of maintenance through Methadone clinics until Suboxone, and other Buprenorphine products.

Currently, inpatient treatment has shared the load with outpatient treatment. Intensive outpatient programs utilize group therapy, education, medically assisted treatment and individual sessions to prepare the client for long term recovery management. Outpatient treatment is less disruptive, and the clients can attend treatment around their daily schedules and work. With medically assisted treatment, a heroin addict can get past the withdrawals and attend treatment long enough to learn long term coping skills and how to avoid relapse. This has been a major improvement. Although withdrawals from heroin won’t kill a person, the withdrawal is so painful that most people will not make it through the withdrawals without using heroin. Then, because they remember the pain of the withdrawal, they don’t try, or they go to a Methadone clinic to get maintenance doses. There are pros and cons to Methadone treatment, and I won’t get into that here. The good news from my perspective is Buprenorphine. Suboxone, the most popular form of Buprenorphine, acts on the opiate receptors and stops withdrawal (an oversimplification)– it’s an amazing drug, and you have to read the scientific explanations to really understand it. When a heroin addict can enter treatment without the fear of withdrawals, they can learn the same coping skills as the alcoholic to start a long term recovery management program. Addiction treatment which aims at drug free recovery is similar for alcohol, cocaine, opiates, benzos, etc.

No drug like Buprenorphine is a cure-all, it’s just a beginning, a tool that allows the heroin addict to enter treatment and establish a recovery routine that’s life long. The goal is to wean off the Buprenorphine once the person is established in recovery. We’ve seen great results with this model. Yes, heroin addiction is a huge national problem, but treatment works. Relapse happens, as in all medical conditions, but relapse is not a necessary part of the recovery process – it doesn’t have to happen. Many heroin addicts enter treatment and never use again — it can happen and it does. The old idea that treatment doesn’t work, especially for heroin addicts, has to be smashed. Treating heroin addiction is the fundamental solution to the heroin epidemic. The problem is that not all treatment efforts are equal — we must establish very strong national standards of treatment based on what works.  I’ll write about the stigma of heroin addiction in the next few days.

Understanding Heroin

Understanding heroinIt’s difficult to find fundamental solutions when a problem is misunderstood as symptomatic of something else – the application of symptomatic solutions to perceived symptomatic problems leads in circles with no real resolution. Heroin, though it’s been around since at least 3400 BC, is still misunderstood. How can this be? Drug smugglers and dealers have a better grasp than our officials tasked with dealing with the heroin problem. They understand the fundamental nature of an addictive drug. They know that addicts come from all walks of life, and that once addicted will pretty much do anything to get the drug. When there’s a demand for a product there’ll eventually be supply. Government efforts to deal with addictive drugs have focused on supply, trying to stop the supply. A current Presidential candidate wants to solve the heroin problem by building a wall at the southern border. Heroin addiction is a not a problem that’s created by porous borders.

Fundamental solutions to heroin addiction, and addiction in general, will originate on the demand side. Prohibition ended in failure because the demand for alcohol overwhelmed restrictions on supply. It’s my sincere belief that if all the money now put in the War on Drugs were put into education, prevention and treatment, we’d be much further along in the development of fundamental solutions.

There are few real conversations taking place across the US that deal with fundamental solutions to the fundamental problems of addiction. Addiction is mainly misunderstood, especially heroin. Below is a list of myths and old ideas from www.alcoholrehab.com that don’t hold true with all addicts:

Drug Addicts Fit a Stereotype

The stereotypical drug addict is somebody who:

* Spends a great deal of time in alleyways in the bad side of town.
* Have legal problems and a criminal history.
* Steal from family and friends.
* An individual who wears dirty unkempt clothing and doesn’t invest much time into personal hygiene.
* They move from low paid job to low paid job or are more likely unemployable.
* Estranged from their family.
* Sad people who have nothing good in their life.
* Drug users are stereotypically under 40 years of age.
* Junkies have no ambition in life.
* They are usually homeless and live in derelict buildings with other junkies.
* They are unable to maintain a healthy romantic relationship.
* They are usually looked upon as a lowlife in their community.

The reality of drug users can differ greatly from the stereotype. Many substance abusers have a well maintained addiction. These are often individuals who:

* Never visit back alleyways in the seedier parts of town. The person supplying them with drugs may even be wearing a suit and working in an office.
* Have never had any legal problems or be on the police radar.
* Most addicts have never needed to steal money from family and friends.
* They may wear expensive clothing and be perfectly groomed.
* They may have a successful career and by highly respected by their peers.
* Many addicts are loved and cherished by their family and friends.
* They can appear at least outwardly happy and be extremely positive about the future.
* Drug addicts can be of any age. There are an increasing number of elderly people who are abusing drugs – it has even been referred to as a hidden epidemic.
* These individuals can be highly ambitions and driven people.
* They may live in a big expensive house.
* They can have a loving partner
* Many addicts are highly respected in their community. Most of the people who know them would not even guess that they had even tried recreational drugs.

The stereotypical image of the drug addict can have negative implications. It makes it easier for people to hide their substance abuse problems. They can kid themselves that so long as they do not fit the stereotype they do not really have a problem.

Understanding the problem as one that can affect anyone, forces the realization that it can be a brother, a daughter, yourself,  a next door neighbor, a boss, a physician, etc. Education and prevention entail deep understanding and a change of mind regarding mood-altering drugs. It takes addiction away from moral judgment to a place where reason, understanding and choices play a larger role. Maybe kids should understand that they don’t have to drink alcohol or smoke pot when they grow up, that a life of abstinence is a good choice. It also means that just because someone chooses to use drugs, it doesn’t make them a terrible, immoral, weak person. If someone develops an addiction problem, it’s a medical concern that will respond to treatment. Once we take the mystery and the myths away, we can rationally, intelligently and objectively search for and find fundamental solutions. Heroin seems like a new, scary problem, but heroin addiction is an old problem – is the same as painkiller addiction to an opioid — both can happen to anyone — both are treatable.

Heroin Addiction and Recovery Management

Heroin addiction and recovery management

Atreating addiction

Treatment of heroin addiction is only the first step. All addicts who want to recover should first learn about heroin addiction and recovery management. Most treatment for heroin addiction includes medication to get past the withdrawals. Buprenorphine and Methadone are the two primary drugs used for detox and maintenance treatment. Maintenance treatment might call for reassessment as new shorter term detox methods are possible. The goal of addiction treatment is to become drug free as soon as possible. Unless there’s medical justification for taking a drug like Suboxone (Buprenorphine) long term, then detox entails an end date to stop usage of detox medication.

At least Intensive Outpatient treatment is necessary, in most cases, to treat addiction, especially addiction to a powerful narcotic. There’s nothing easy about detox, treatment and recovery from heroin addiction. When I write heroin, insert opioid, because heroin is an opioid drug like pain-killing drugs prescribed by a doctor. Addiction to these drugs consumes a person and creates changes in the brain that take time to heal. Addiction makes changes in a powerful part of the brain, and in order to recover, a person needs time and treatment/counseling and long term support from recovering addicts who understand addiction and recovery management.

This is from Addictions.com:

Support groups are also extremely helpful during heroin addiction recovery. Many people are comforted by knowing and speaking with others who are dealing with the same issues they are. Heroin recovery is difficult, and relapse is common. But, if you attend treatment and ask for help, it can be made easier and you can be better protected from the issues that plague many recovering heroin addicts.

Trying to deal with heroin addiction without professional help is risky, and it usually doesn’t work. When most heroin addicts “kick the habit” and begin to feel better, they think they’re cured, but after a short while they begin to crave the drug and have no way to deal with the craving. They might get down on themselves and believe they’re just weak and destined to use heroin. If a person doesn’t understand the nature of addiction and what to expect after stopping the use, and if they don’t have support from others who’ve been through the experience, their damaged and insufficient will power gives into the craving and they return to the drug.

It’s best to seek professional help, and it’s best to learn about recovery management. For any other major problem we find it fairly easy to seek out help from professionals, why would a person not seek help from something life threatening like heroin addiction?