Category Archives: Heroin

Worse than ever: Pain pills and heroin use

More people are dying from opioid overdoses than traffic accidents, yet no one seems to notice or want to address it. As commented on in the April 17th issue of The New York Times, “Serving All Your Heroin Needs”:


Meanwhile, the victims – mostly white, well-off and often young – are mourned in silence, because their parents are loath to talk publicly about how a cheerleader daughter hooked for dope, or their once-star athlete son overdosed in a fast-food restaurant bathroom.


Look at the numbers: 24,000 deaths from opioids. While the pain pill machine goes about its business of producing more and more addicts, no one says a thing.


For parents who do stand up and speak, the response is underwhelming. I attended an event at a large suburban high school billed as a community forum to examine the problems of recreational drug use, prompted by the drug death of a 17-year-old. Her father, Tom, spoke very movingly and passionately about his loss, but the audience was almost devoid of parents.


Why? Is it fear of hearing a contemporary bare his soul about a parent’s worse nightmare? Is it hoping that ignoring the problem will make it go away – soon they’ll be off to college anyway? Who knows? But the absence of any passion – any demand for action – was striking.

Stimulant use among 26-to-34-year-olds doubles in four years

The Sunday Times had a second story, this one on abuse of ADHD medications, titled “Workers Seeking Productivity in a Pill are Abusing A.D.H.D. Drugs.” Stimulants like Adderall, Vyvanse, and Concerta are migrating from school settings to the workplace. They’re now in play in demanding professions:


These lawyers said they and dozens of young colleagues at their firms had casually traded pills to work into the night and billed hundreds of extra hours a year in the race for partnerships.


Overuse leads to rapid heartbeat, acute anxiety, hallucinations, sleep deprivation, and addiction. Just the type of professional you want working on your case or in your firm or client base. Outside of the workplace, these pills are “Mommy Crack,” great for staying thin and multitasking on the home front.


Again, this phenomenon starts in high school, where students sell pills or give them to friends to help with academic focus and performance. They’re great for answering the four or five extra SAT questions needed to break 700 and pulling all-nighters for studying and exams. Whether it be weed, alcohol, uppers, or downer, students in every high school know who is selling or providing drugs and drinks, but are unwilling to name names out of fear of being ostracized or to protect their sources.

Silence and indifference

In any case – at the parent or student level – we have created a culture of silence and indifference not seen since the AIDS epidemic. We are beginning to make the connection between binge drinking and date rape among high school and college students, but a similar connection must be made between pharmaceutical companies’ and doctors’ profits and drug dependence and deaths. In both instances, the big businesses supplying the alcohol and pills pay less than 5% of their collateral damage and can never atone for their increasing death toll.


Not to minimize the AIDS epidemic, but what we’re dealing with here is on a very large scale. The Band Plays On, with alcohol and opioid deaths exceeding 100,000 per year. When will enough of us join together to stop this growing tragedy?

Becoming addicted to pain pills

Perhaps understanding how opioid dependency develops will be the first step in generating more public support for taking on the drug industry.


For those of you unfamiliar with how someone becomes dependent on pain pills, here is how it happens. People have an injury, surgery, or dental work and are given a prescription for 30 pain pills. After just a few days, it takes more pills to obtain the same level of effect in dampening pain. Most patients learn to tolerate their pain and supplement with over-the-counter medications. But then once they near the end of their supply, there is the problem of stopping. Stopping abruptly leads to uncomfortable physical symptoms, so most people taper off. But addicts are not like most people, and they don’t stop.


The dependency cycle


The dependency cycle begins when a person ups the dose, decides it’s too uncomfortable to quit, or in fact likes the physical and psychological effects from the pills. These narcotics can give a euphoric sensation of withdrawing from the world. Users will continue to seek prescriptions until their doctors decide to cut them off. From there, they turn to doctor-shopping and online ordering, or worse.


Switch to heroin


Many users – or addicts – switch to heroin because it’s cheaper and more readily available. It also can produce a really powerful and pleasurable body jolt the first few times. This motivates the addict to “chase the high” – trying to reproduce the feelings from that first time by increasing the amount, potency, or by mixing with other drugs. Very dangerous and a big reason for all the deaths. A similar process occurs for other narcotics.




Painkillers are meant for acute pain, not chronic pain, as are most other drugs, such as anxiety or sleeping medications. But remember, this starts with the doctor handing out the initial 30-pill prescriptions or samples provided by Big Pharma, enough to hook some patients, as the drug companies know all too well. And it’s no secret that doctors are liberal with the scripts – even doling out Norco (acetaminophen and hydrocodone) by the handful to newly-postpartum nursing mothers. It’s hard to keep saying no when it’s always offered.

Transforming public opinion and policy

Attacking the supply side seems like a good first step, but that means overcoming deeply entrenched social stigma, leaving the shadows, and finding the courage to tell our truths – namely that these problems don’t exist in a vacuum. With opioid-related overdose deaths occurring every four minutes, we can no longer pretend that these “dirty” deaths are only happening to strung-out junkies living on the streets in the inner city. They are happening to us, our families, and our friends. Fortunately, new generations are stepping forward to start conversations aimed at transforming public opinion and policy.

To Tom, the father who spoke out at the community forum, you are not alone, and we will not forget your daughter.

Why heroin?

Why do supposedly smart people become addicted to heroin? Why do they use it in the first place, when it has a reputation as a low-class, junkie drug? What’s the attraction? What’s the high?

With the recent death of Philip Seymour Hoffman, I asked myself those questions. As a person in recovery whose drug of choice was primarily alcohol, I experimented with cocaine, used Xanax occasionally to sleep, and smoked a joint now and then – but never, ever thought of heroin.

But it’s not just famous people who die of overdoses from the drug – it’s people I know in my circle of friends, my relatives and in our newspapers. As part of our efforts to make available an antidote to heroin overdoses to first responders (the Naloxone spray), family members came forward and told their stories of loved ones lost to the drug. Very sad. And these were middle-class young adults. It migrates into the best families, but why? Why use it when it has a reputation as a drug no one wants to mess with?

Understand the draw

First, to understand the draw of heroin, you have to understand what it does. According to Robert Aaron, the man who was arrested for providing dope to Hoffman, heroin has “good qualities”:

A lot of times you have a deadline and you to work for 24 hours. This lets you do it with no pain, no tiredness. If I have to write a book, get me high – I’ll have that book written in two weeks. You’re lucid. And emotions don’t affect you as much – your anger – it bottles up your feelings. It makes you more rational, or you think you are, anyway. I’m a lifelong insomniac. …. Everything has it good points and bad points. The bad point is the dependence.

So there you have it: the perfect study drug to pull an all-nighter on. Or to learn your lines and perform in front of the camera. Or to deliver a speech honoring a family member or friend, as a relative of mine did. It was a brilliant performance – everyone said so – but I could tell by his eyes he had used, which he confided to me while in treatment. And far too soon, he was gone.

I’ve also heard the first few times, it’s better than the perfect orgasm, better than any sex. But then, of course, the intensity lessens each time and the user begins to chase the high, hoping the next time will be like the first time. The irony is that heroin robs many users of the ability and desire to obtain an erection (see Amy Winehouse’s You Know I’m No Good, “Upstairs in bed with my ex boy / He’s in the place but I can’t get joy”).

The connection

As you probably already know, few drug users start out using heroin. In fact, many heroin users are first exposed and addicted to prescription pain medication. You may be wondering about the connection between pain medication use and heroin.

I’d always known that many people with injuries or post-surgical trauma become dependent on prescription pain medications such as oxycodone, hydrocodone and Percocet (oxycodone + acetaminophen). It’s a common phenomenon when taking these pills for only a few days, as I discovered after undergoing hip surgery. I was very aware of withdrawal symptoms when stopping after three weeks of use, and I was very conscientious about limiting the amount per day and the duration.

However, pills are different from heroin in that they numb you out, slow you down and allow you to withdraw from the world. Some people like these feelings because it helps them cope with other problems, they are pain-averse, or they can’t tolerate withdrawal symptoms. So when a pill person first touches heroin, there is a “WOW!” effect that is unlike any pills, which are all about dulling senses, not first focusing the mind and relaxing feelings and then withdrawing into the inner world of nothingness. That is the attraction of the drug, what makes it so popular, and what I never understood until Aaron came forward with his story.

Cheaper and more powerful

With increasing pressure on doctors to limit the number of prescriptions and number of pills prescribed, along with central registries for prescriptions, supply is becoming more limited. Also, copays can be high – higher, even, than the price of heroin. So users who want pills are increasingly buying over the Internet or from friends or dealers. Once they get into this illegal market, the movement to heroin is common.

Because users tend to associate with each other, word gets out that heroin is cheaper and more powerful than pills. More bang for less buck. People who use drugs encourage their friends to join them because it makes them feel better and it helps them justify their use. Dealers also will tout heroin as a better alternative, offering free samples (“One snort won’t hurt; you can control it.”).

Chasing the perfect high

All junkies believe they know how much to use without killing themselves because they successfully do it all the time. But, as we all know, this is a delusion because they are both chasing the perfect high – the one combination of drugs that will really make them feel like the first time they used – and ignoring the fact that due to increasing tolerance, they require higher-potency drugs to do so. Unfortunately, their belief is only valid until it doesn’t work. And then, they are dead.