Heroin: An equal opportunity killer

Like most tragedies, it begins innocently enough. People get sick. They go to their doctors. The physicians prescribe them medicine. They take it to get better. It’s all legal.

Then, the medicine runs out. Without a lawful way to acquire pain prescriptions, working professionals, college students, and even high school kids begin looking for a cost t-effective alternative. They find heroin.

"We are seeing a whole new subculture of addicts due to the misuse of prescription drugs and opiates," says special agent Gary Tuggle, who’s in charge of the Drug Enforcement Agency's Baltimore District Office.

For the past two decades, doctors have been overprescribing drugs like Percocet, which costs about $25 a pill, and OxyContin, which costs a staggering $80 per pill. Once people no longer have legal access to the drugs -- or can no longer afford them -- they turn to heroin, which only costs $13 a capsule.

This burgeoning heroin subculture in Maryland claims more and more lives every year. In South Maryland, which includes Calvert, Charles, St. Mary’s and Prince George’s counties, there were a total of 27, 38, and 39 heroin-related deaths in 2011, 2012, and 2013 respectively, according to the latest data from the Maryland Department of Health and Mental Hygiene.

The reason heroin was able to spread and proliferate Maryland was because, “the demand became huge,” explains Carol Porto, Director of the Carol M. Porto Treatment Center, a drug rehab facility in Frederick, Maryland.

“Most of those using heroin began [as] patients of doctors treating their pain, either from surgery or injuries. This is true for 75% of the patients we have been treating here,” says Porto. “Doctors are not trained in addiction medicine, do poorly in managing patients on opiate pain meds and seem helpless if they discover their patients are using more of the med than prescribed. They usually stop prescribing, sending the patient into a withdrawal that is like a really severe flu. The patient ends up buying the pain pills illegally. They soon learn heroin is the same drug and much cheaper. Thus, the demand increased.”

The problem is much worse across the rest of the state. In 2011, 2012, and 2013, there respectively were 247, 392, and 464 heroin-related deaths in all of Maryland.

Many of these people were younger than 35, too. The data reveals that 35% of the people who died from heroin in 2012 (139 people) were 34 years of age or younger. In 2013, the amount leapt by five percentage points to 40% for a tragic total of 183 people under age 35.

“Over the last decade there has been a marked increase in the abuse of prescription drugs by young adults. Young adults (age 18 to 25) are the biggest abusers of prescription opioid pain relievers, ADHD stimulants and anti-anxiety drugs,” explains Doris McDonald, Calvert County Health Department’s Director of Behavioral Health.

“Motivation for use is varied, from experimentation, to deal with problems, relieve pain, get high, relax, lose weight, study, feel better, sleep etc. Prescription drugs are often thought of as safe and somehow different from street drugs,” she says. “In young as well as older adults, abuse of prescription drugs may be precipitated by the use of a legally obtained prescription medication that then interacts with genetics and environmental factors to trigger misuse and addiction.”

However, McDonald notes that heroin is a farther-reaching issue with a more massive impact than is believed or portrayed.

“It is right to call it an epidemic. It is misleading to call it a heroin problem, because that is not the only issue,” she explains. “Heroin users have a long history of being stigmatized, something that only happens in ‘other’ families. This epidemic is impacting everyone, no matter the age, intelligence, or economic status.

“This is an equal opportunity killer.”

Things are only getting worse, too. This past July, state officials said that Maryland saw a 33% increase in drug overdose deaths in 2014’s first quarter in comparison to the same time last year. According to a report from the Maryland Department of Health and Mental Hygiene, 148 of the 252 total drug overdoses from January to March were related to heroin.

"While I'd like to stand here and tell you that this is getting better, it's not," said Governor Martin O'Malley. "It's getting worse, which is why we are redoubling our efforts."

Last June, the governor created the Overdose Prevention Council in order to focus on the heroin epidemic plaguing the state. The health department also launched an awareness campaign to help people not only get the treatment they need, but to also help others identify the signs of a heroin overdose.

“Patients with heroin or pain pill use disorder are most effectively treated with a medication, Buprenorphine,” explains Porto. “This is a research based fact, supported throughout the state. Problem is [that] there are very few doctors who are licensed to prescribe the medication and most do not take insurance.”

To help addicts get the treatment they need, Maryland has also been equipping the right people with the right tools. It trained some 2,000 people across the state to use the overdose reversal drug Nalaxone.

“It’s a dogged problem,” says Bernard McBride, director of the Behavioral Health System of Baltimore. “It’s been around a long time. But I think there’s reason to be optimistic.”

“Treatment works,” says McDonald. “There are now several options for people addicted to opioids, including medication. Opioid use disorders, like other substance use disorders, are brain diseases. As with other illnesses, the earlier treatment is begun, the better the outcome.”


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