– J. David Hammond, MD
Philip Seymour Hoffman. Another talented young man whose battle with addiction ended his life all too soon. Whenever a public figure or celebrity dies in a public way from addiction, the media turns its attention once again to the subject of substance abuse. Articles are written, reports are filed, and everyone collectively pauses a moment to reflect on the sadness and loss of another future never to be realized. Then the moment passes, other things grab our attention and the plague continues. Surprisingly the substances killing our youth today are not very different from the drugs that took our brothers and sisters forty years ago. The cycle continues unabated.
Recently the Drug Enforcement Administration released a statement identifying prescription medications as the biggest drug problem in the United States. With the ever-expanding prescribed drug problem being at the forefront of discussions, some attention has been diverted from the illegal drug issue. Chief among these is heroin; one of the oldest known and most dangerous drugs available. Prescription pain pills often are an introduction to the effects of opiates. Once a tolerance to the pills is acquired, a more direct route of administration must be sought. The more direct the administration, the more dangerous the drug becomes.
The Centers for Disease Control and the National Survey on Drug Use and Health in 2012 released the following statistics regarding heroin use in the United States:
- 3.8 million people report having used heroin at least once in their lives.
- 560,000 people used heroin in the last year.
- 338,000 people used heroin in the last month.
The incidence of heroin use in people incarcerated is almost 25% These numbers reveal an increase in the incidence of heroin use in our youth population. Compared to the survey in 2005, the incidence of heroin use by people age 18-25 increased by 0.2 percent. A small increase in percentage, but still a large number of people. And, with the direct IV administration of the drug, the dangers of overdose are quite significant.
With the increase in exposure to IV narcotics, there is a subsequent increase in emergency room visits, hospital admissions, and overdose-related deaths. The CDC reported that in 2002 the number of emergency room visits related to heroin use was 93,519. In 2008 that number had more than doubled to 201,000. Subsequently, the number of heroin-related deaths increased to an average of 2,000 per year. The most common cause of deaths was:
- Overdose (21.6%)
- Homicide, suicide, accidents (19%)
- Liver disease (15.2%)
- Cardiovascular event (11%)
- Cancer (11%)
The statistics from 2014 are sure to be even more startling. The increase in the use of oxycodone by prescription has introduced an entirely new cohort of people to the use of opiates. Recently the street value of oxycodone actually significantly exceeded that of heroin. In short, once someone becomes opiate dependent, it is cheaper to substitute heroin than to continue to buy oxycodone. The problem then becomes expansive. What is the person buying? Is it really heroin? What has been added to it? How potent is it? All of these questions relate directly to the most concerning one, “how much of this is too much?”
Recently, a new problem has surfaced. The northeast U.S. has seen a significant increase in the number of overdoses and deaths from a new combination of heroin and fentanyl. CNN reported that in western Pennsylvania six counties reported 22 deaths in a single week in January. During the same week, Pittsburgh reported 15 deaths alone. All deaths were from an overdose of the heroin and fentanyl combination. The mixture referred to on the street as “Theraflu” or “Bud Ice” resembles an old heroin mixture known as China White. The problem is that the mixture is often up to 50% fentanyl instead of heroin. Gram-for-gram Fentanyl is 10 times more potent than heroin or its breakdown product morphine. Fentanyl is used in hospitals and is usually dosed in micrograms due to its potency and respiratory suppression effects. It’s easy to understand how an overdose occurs. If the person injecting the suspected heroin does not adjust the dose by one-tenth—severe respiratory suppression and subsequent death easily occur.
Law enforcement and the CDC have started publishing warnings in the most highly affected areas, naming the compounds to be wary of on the street. The difficulty is that many times the dealers will change the name of their product in order to keep selling it. Also, often the dealers themselves are unsure of the product’s components. Many times, the victim in the middle of severe opiate detox, will use the product knowing it may be mixed with fentanyl and attempt to adjust the dose accordingly. Given the very small amounts of fentanyl necessary tor respiratory suppression, the ability to adjust safely while using IV drugs is difficult – if not impossible.
With the growing prescription drug problem leading to more opiate addictions, and the subsequent increase in the use of IV narcotics including heroin, the number of overdoses and deaths will continue to rise. Add to this the use of fentanyl in combination with heroin, and the number of young people who fatally overdose will continue to increase into the foreseeable future. While the celebrity deaths continue to catch our attention as a collective consciousness, there were 22 non-celebrity deaths in six counties in Pennsylvania in one week in January alone. Were those deaths any less tragic?
The general population of the United States has become increasingly excited about the legalization of cannabis. Subsequently, media attention is being paid to states that have recently made drug use a socially acceptable recreation. While the virtues of recreational cannabis use are being argued, the bigger questions are being ignored. As a society, what can be done to address the growing addiction problem facing our young people? With the increasing prescription drug problem, how many more opiate addicts will turn to heroin? Of those that use heroin, how many will overdose? How many more will die from an old school drug made new again?
When I first started at Palmetto, I was unfamiliar with the concept of AA. I had always believed, as a lot of people do, that if you were an addict then it was because you were weak-natured and unable to take responsibility for your actions. This could not have been further from the truth. As I became acquainted with the program and witnessed the true nature of addiction, I realized that “those people” were no different than I was. I also realized that there was no such thing as a “typical addict.” Addiction is no respecter of person, income, age, race, religion, sex, or social setting. The patients I have seen at Palmetto have come from all walks of life but they all have one thing in common: the disease of addiction.
We have all heard the old saying, “Admitting that you have a problem is the First Step,” but unless you have been there you can never know how hard this can be to do. The wording is, of course, optional– so long as we express the idea and voice it without reservation that we are alcoholics or addicts and cannot manage our own lives. We admitted that we could not control our drinking or using after we got started, a seemingly allergic reaction where one drink or use demands another. We admitted that we could not remain abstinent after we had stopped, because we were irritable, restless and discontent while sober. We admitted that we could not manage our own lives into a happy, joyous and free existence so as to never again have to drink or use.
To truly admit that you are powerless and that a substance has control of your body can be difficult. I have seen people come to Palmetto and go through the motions of the First Step and never fully realize exactly what it is. They may fool their counselor and their peers in the community, but only they know if they have not really taken the First Step. Then, there are others who completely give in and truly embrace that First Step. When this happens, you notice a real change in them. It’s like someone lighting a candle in a dark room. To see this transformation in a patient as they bare their soul to their counselor and group and then lay down the burdens that have plagued them for so long is a remarkable thing. Unless you take the First Step you cannot begin the road to physical, mental, emotional, or spiritual recovery. The importance of truly taking the First Step cannot be understated.
I have seen thousands of people come to Palmetto for a new lease on life. Whether brought here by family or a monitoring agency, or they have finally hit “rock bottom” and realized that they need a complete change in their life, the reasons are as varied as the patients themselves. I feel blessed to be able to help so many individuals, from across the United States and even the world, begin the crucial First Step of their journey to recovery and sobriety.