The ‘gateway’ to heroin addiction

With opiates at the top of accidental deaths, battling the ‘epidemic’ is more important than ever

UNION COUNTY — Heroin use continues to rise in New Jersey at an alarming rate, especially in upper-middle class suburbs. In fact, the skyrocketing use of heroin and other opiates has become the number one health care crisis confronting the state and Union County. It is also killing young adults at an alarming rate.

The problem, no longer isolated to the streets of Newark or Camden, is killing young adults 18 to 25 in towns like Cranford, Union, Rahway, Clark and other bedroom communities in Union County. Drug overdose deaths now surpass deaths from motor vehicle accidents, which had always been the leading cause of accidental death in the United States.

Prescription drugs were implicated in the deaths of more than 700 New Jersey residents in 2011 and 2012, according to statistics released by State Assistant Medical Examiner Dr. Roger Mitchell. The number of drug deaths in the state rose from 843 in 2010 to 1,026 in 2011 and 1,294 deaths in 2013. Approximately two-thirds of all those deaths involved prescription drugs rather than solely illicit street drugs.

A report issued recently by the Task Force on Heroin and Other Opiate Use in New Jersey’s Youth and Young Adult identified heroin and opiate use as the number one healthcare crisis confronting the state.

It pointed to a five-year increase of more than 200 percent in the number of admissions to licensed or certified treatment programs for prescription drug abuse, and a 700 percent increase over the last decade.

According to 2014 state report “Confronting New Jersey’s New Drug Problem,” a strategic action plan to address a burgeoning heroin-opiate epidemic among adolescents and young adults, this is a new kind of drug crisis, one that is affecting countless young people previously thought to be at low risk of addiction.

For example, in 2012, the last year the state had statistics, there were more than 8,300 admissions to state licensed or certified substance abuse treatment programs due to prescription drug abuse, an increase of over 200 percent over the last five years. Alarmingly, forty percent of opiate admissions for treatment involved young adults ages 25-years-old or younger.

Critical here is that prescription opiate drug abuse is considered a “gateway” to street heroin use
Many users, the report noted, begin their journey to addiction through legally prescribed pain medications, but once addicted it is a slippery slope to moving on to heroin. The need to maintain a supply of pills becomes extremely expensive and more often than not the only choice is to move on to heroin, which is more affordable, and deadlier.

By whatever means and for whatever reasons, adolescents and young adults first come to use these powerful medications, such as OxyContin, Vicodin, Percocet and Percodan, and if addiction sets in, many will be driven to commit prescription fraud, thefts, and other crimes to maintain their supply of pills.

Finally, in desperation, they can often turn to street heroin in a desperate effort to feed their addiction.

Although prescription drugs seem to have little in common with heroin, the state, along with addiction therapists, maintain the alarming statistics of addiction in New Jersey cannot be addressed without starting at the beginning: the use of legal opiates.

“The line between legitimate medications and illicit street drugs has become blurred, and there is a disturbing new relationship between the doctor’s office, pharmacy and back-alley drug pusher,” the state report stressed, adding this unprecedented need for coordination brought this matter within the core mission of the Governor’s Council on Alcoholism and Drug Abuse.

“This is hardly the travditional path to heroin abuse and that is one of the things that make the present situation so troubling. Because readily-available prescription pills have become a gateway drug, heroin is finding its way into the world of people who never imagined they would ever confront this terrible substance,” the state report said.

Modern day substance abuse culture in New Jersey, particularly Union County, has changed in ways that shock those who never considered the possibility that drug addiction would become a part of their life and that of a loved one, particularly a teen or young adult.

Alex, 22, for example, whose real name has been changed to protect his identity, admitted in an interview with LocalSource he never thought for a moment that taking OxyContin from the medicine cabinet in his own bathroom would lead to heroin addiction, but it did.

“Look, I was 17 and felt invincible,” he says quietly with a slight, sheepish smile. “I mean, I live in Clark, my parents are good people, they even bought me a Jeep for my 17th birthday. I played sports since I was a little kid, and excelled in high school. No kid could have had a better environment than me, but I screwed up,” said the tall, thin, dark haired recovering heroin addict.

The Clark youth went on to describe how he was able to “score” OxyContin, Vicodin, Percocet or Percodan for months, either through friends, on the street, or taking it from the medicine cabinets of relatives.
There came a day, though, that this opiate no longer gave him a high.

“I had to have it just to feel normal and not go into withdrawal and it was costing $8 to $20 a pill,” Alex said, his voice growing tense as he recalled this desperate time in his life.

What followed was his descent into using heroin because it was readily available, cheap and curbed the withdrawal symptoms. Compared to spending what he had been for prescription drugs on the street, he could score 10 “bags” of heroin for $60.

Withdrawal from heroin, which can begin within hours of the last use, comes with intense physical symptoms, including cold sweats, extreme discomfort, nausea and vomiting.

Alex never did use heroin intravenously, though. Instead, he smoked it using a straw, tin foil and lighter, but the effect was the same and he needed more and more just to “feel normal.”

It was a vicious cycle, one that made him even contemplate suicide at one point, he said. However, as his addiction spiraled, thankfully his parents began to suspect their son was in trouble.

“I remember their faces and my father crying. I don’t think I ever saw him cry before,” said Alex, his brown eyes filling with tears momentarily. “It tore a hole in me. I thought they would hate me, but they loved me enough to get me help and save my life.”

Alex entered a rehab facility in New Jersey just a few days later and remained there for several months, and says he has stayed clean for three years. When he talks about his recovery his voice is strong, punctuated with facts about the heroin epidemic in New Jersey.
However, he is the first to point out that every day that goes by he is in recovery.

“I was one of the lucky ones. I didn’t die. I get to live the life my parents gave me and make them proud. I didn’t end up dead with a needle stuck in my arm,” he said, adding that statistics never lie.

“We have a heroin problem here in Union County, maybe not as bad as Ocean County, but kids are dying here with needles in their arms because they didn’t know where to turn. We need to be aware that this is a full blown epidemic. People think heroin addiction doesn’t happen here in towns like Clark, but it is here and it could be anybody’s son or daughter who overdoses tonight,” Alex said.

Prescription drug abuse is now a health epidemic in America, according to the Centers for Disease Control and Prevention, because, OxyContin, like heroin, is an opiate and opiates are addictive.

Heroin can be sniffed, smoked or injected. Euphoric effects appear quickly and can last for several hours, depending on the amount used. Injection poses the greatest threat by putting large amounts of heroin into the bloodstream at once. The chance of surviving an overdose depends greatly on how fast one receives medical assistance. For many it is too late because street heroin today is far more lethal than it was just few years ago.

Dr. Thomas McLellan, former Deputy Director of the White House Office of National Drug Control Policy, offered chilling testimony to help put the magnitude of the problem in perspective.

“If I said what do you think is killing Americans more than anything else, a very good answer would be car accidents. It’s not, its number two. Gunshots are number three. Prescriptions, not heroin, prescription opioids is the number one cause,” McLellan said in the state report.

But, because opiates are a gateway to heroin, and easily obtained anywhere in the county or state, it ultimately becomes easier and less expensive to buy heroin from a street dealer than “pill mill,” as Alex found out.

The state report also stressed it was a misconception to think the low cost of street heroin might result in lower purity levels, because nothing could be further from the truth.

“To the contrary, our street heroin is vastly stronger than the heroin that is sold in other jurisdictions,” the state report pointed out, adding that typical purity levels here in New Jersey exceed 40 percent. To provide some context, the state report explained that in the New England area, the average purity level is around 15 percent.
“Our heroin is cheap. Our heroin is also potent. That is a deadly combination,” the state report said.
On the other hand, the DEA reports, for example, that while in some parts of New Jersey heroin is often sold at 40 percent purity, in others that same level has reached as high as 80 percent.

This is especially troubling because novice heroin users, such as those progressing to heroin from prescription drugs rather than other illicit street drugs, will have neither personal experience or support from more experienced users. Without this street help, the risk of underestimating purity levels and ingesting too high a dose can be deadly.

“This makes ingesting street heroin like playing Russian roulette,” the state report said, adding that inconsistency in heroin purity, coupled with the inexperienced novice heroin users, “is an especially dangerous combination of circumstances that leads often to overdoses and death.”

Plus, the report noted, the purer the heroin, the easier it is to metabolize. Today, heroin on the street is so potent, users can get high just by snorting or smoking it. This not only makes heroin more seductive, but harder for families and friends to detect ongoing abuse.
“Many heroin users today cannot be revealed by needle tracks on their arms. For these users, the scars of their addiction is terribly real, but harder to see,” state officials said in the report.

NEXT WEEK: What the county and state are doing to combat the heroin epidemic and how successful rehab is for the addicted.

One Response to "The ‘gateway’ to heroin addiction"

  1. webmaster   September 12, 2014 at 8:00 am

    I am a prominent addiction/recovery therapist in Massachusetts and I’m sending clients and client families out the door with the link to your newspaper and Cheryl Hehl’s outstanding series on the heroin epidemic. Her work is well researched, thoughtfully organized, informative and most useful. Kudos!

    Mark B. Dunay LICSW LADC1