Heroin: The Epidemic

Heroine -- An illegal, highly addictive drug processed from morphine, a naturally occurring substance extracted from the seed pod of certain varieties of poppy plants. It is sold on the streets in multiple forms, ranging from white or brownish powders to a black tar and rock-like substances. In powder forms, which usually originate in South America and are cut with anything from sugar, startch, or powdered milk, it can be snorted and smoked. In the black forms, coming from Mexico, it usually gets melted down and then injected directly into the user's vein.

This drug has become extremely prolific in my area, and seems to be taking suburban America by storm. From what I see on a day to day basis, it has quickly passed methamphetamine in street popularity and doesn't seem to have much in the way of a rival. It is taxing the system in so many ways that its unreal. Law enforcement agencies are getting overwhelmed as they to stop the flow of this drug into our area from places like Detroit. They are also dealing with thefts and violent crimes committed by addicts just trying to find enough money for their next fix. The medical field, being ourselves in EMS as well as the hospitals, is also having trouble. An already taxed health care system is now being pushed even further, sometimes to its limits, by a seemingly constant barrage of patients who have overdosed, presumably because they are pushing for a “better” high, or they just got heroin from a batch that is stronger than they are used to. The nation is now in a shortage of Narcan, the well-known opioid antagonist that is now seen on drug store shelves and in police cruisers, rather than just in our first out bag. Ambulances are rushing to scenes of heroin overdoses, having to treat these patients by supporting their airways, and most often using our dwindling supply of Narcan to relieve the respiratory depression caused by the drug. Then, those patients get transported to area emergency rooms where they take up precious space in a bed so they can be monitored and released, if they are lucky. Narcan has a much shorter half life than most opiates, including heroin, so these patients may require further treatment in the emergency room as well. Those who don't die from their heroin overdose are lucky.

It is easy to see where heroin is not only a issue for law enforcement and the justice system, but is also well on its way to becoming a health care crisis. It is also easy to see where many of us, as providers, are becoming increasingly frustrated with heroin and its users. For a moment, though, hear me out.

The heroin addict, junky, or whatever you want to call them that was on your cot yesterday, might be tonight, or will be tomorrow, is someone to another person out there. That guy is someone's brother, son, father; the gal is someone's sister, daughter, mother. These people are coming from all walks of life, but why? Heroin didn't just show up a year or so ago; in 1874, heroin was actually marketed to doctors and their patients as an over the counter, non-addictive alternative to morphine. So why now? It seems to me that health care may have done this to itself. For the past decade or so, it has been the common thought among doctors I have known that if someone is in pain, you give them pain medicine. We stopped, “Taking the edge off,” and started giving narcotics to completely subdue pain. Pain clinics started popping up, both honest and dishonest (pill mills, if you will). This went on for years, but then, it just stopped. We have cracked down on the administration of narcotics. Pill mills, basically dealing narcotics under the disguise of doing good, were raided and shut down. The people, who have been addicted to narcotic pain medicine for so long, had nowhere to go. When you can't legally get what your body is now addicted to, what do you think is going to happen?

The truth is, most of the heroin addicts I have talked to started out with a prescription for narcotic pain medicine because of an injury. A few have done it because they used drugs as an escape can just kept moving to harder and harder drugs, but most started out as honest individuals. A lot of people were hard working individuals who hurt themselves at work. A high school quarterback who broke his leg. A veteran paramedic who hurt himself on the job. All of these people hurt themselves, did what their doctor told them to do, and got hooked on opiates. They didn't ask for it, but some research has shown that patient have become psychologically addicted to an opiate on their first does, with physical addiction following within days of continued use. They didn't ask for it, and for most, help wasn't available to them when it came time to stop taking the medication, either because insurance wouldn't pay for it or because it just wasn't available in their area. The prescription(s) ran out, and true addiction is a bitch, so they turned to illegal drugs. First, they bought pills on the street, but at some point, they couldn't get those either, or they just didn't work anymore, so they did heroin instead. Now, here they are on your cot.

My point in all this is that before you get frustrated and berate, belittle, or talk down to these patients (I know none of you would), just consider how they got here to begin with. Very few chose for their life to go down this path, and most don't want to continue. True physical addiction is a hard thing to overcome, and no one can do it without the proper support and help. That support might just start with you.

Stay safe.