Heroin hits home: Threat of withdrawal keeps users hooked
By John Lundy / Duluth News Tribune
People describe heroin withdrawal in different ways.
“You’ll feel the ants crawling on your skin — instant anxiety.”
Richard Howell, a former drug user and dealer who now leads a recovery group at the Damiano Center, said he never used heroin. But he has seen its effects on a couple of family members and many others.
“It’s hard to watch them,” Howell said. “They can’t eat. They can’t stand up. They have stomach cramps. They have muscle aches. They can’t think. All they know is what they need to stop the pain.”
Withdrawal is agonizing; an overdose is potentially fatal. In between, the addiction demands that it be fed, frequently.
Jazzelle Lee Marie Evavold, a 19-year-old from Lakewood Township who died of a heroin overdose earlier this year, described heroin as the monster.
A painkiller from Bayer
It seems like no one would choose to use heroin. Yet the substance associated with 1970s drug culture suddenly has re-emerged within the past couple of years, in the Northland and across the country. Vermont Gov. Peter Shumlin devoted his entire State of the State address to the subject earlier this year.
The number of people admitted for treatment for heroin rose from 81 in 2011 to 287 in 2012 to 400 in 2013, according to the Minnesota Department of Human Services. In Carlton County, the number rose from 19 to 61 to 127 in the same three years.
Heroin-related deaths in Minnesota rose from 19 in 2009 to 98 last year — although that is a preliminary figure — according to the Health Department.
Douglas County has recorded a handful of overdose deaths in each of the past five years, Medical Examiner Darrell Witt said. For the first time in those five years, two of the deaths last year involved heroin, he said.
What’s the medical history of heroin? And what effects does it have on its users?
Heroin, like morphine before it, was derived from the opium poppy. At about the turn of the 20th century, it was sold as a painkiller by Bayer, the pharmaceutical company best known today for aspirin.
It is part of a class of drugs called opiates, said Dr. Elisabeth Bilden, a medical toxicologist at Essentia Health. A larger category, known as opioids, also includes synthetic versions (think Lortab, OxyContin), used to treat pain.
In the 1990s, doctors were pressured to prescribe such medications freely, Delp said.
“Doctors were painted as bad people because we weren’t addressing pain,” he said. “In a large respect, that was stimulated by the drug companies. They were pushing that agenda, and their sales, their profits went up exponentially.”
The most commonly prescribed drug in America is a combination of acetaminophen and hydrocodone — an opioid — according to the Connecticut-based IMS Institute for Healthcare Informatics.
Dr. Charlie Reznikoff, an addictions specialist at Hennepin County Medical Center, traces the start of what he calls “the opioid-prescribing epidemic” to 1996.
Addressing an audience mostly consisting of medical professionals at Essentia Health-St. Mary’s Medical Center earlier this month, Reznikoff said the vast majority of chronic pain patients never become addicted. Studies show about 3-5 percent do become addicted, he said, although 20-25 percent misuse their drugs in some way.
But another study shows that 80 percent of new heroin users started with prescription opioids, he added.
It doesn’t mean opioids shouldn’t be prescribed, he said, but it does mean there’s an inherent risk.
“There is just no prescribing opioids where addictions don’t happen,” Reznikoff said. “If you prescribe enough opioids, you will trigger this adverse reaction called addiction.”
Researchers estimate 7 percent or more of emergency room visits are people trying to get opioids, Delp said. But as emergency department physicians became aware of the problem, they rose to the challenge.
“We made a concerted effort to try to shut that down or reduce the amount that was happening, and to great effect,” he said.
But when one drug decreases, another tends to take its place in a sort of Whac-a-Mole effect, experts say.
“Now we’re going to clamp down on prescription opiates, and it’s going to drive a certain number of people to illicit drugs like heroin,” said Gary Olson, CEO of the Center for Alcohol and Drug Treatment in Duluth.
‘God’s warm blanket’
Users don’t have to inject heroin to get high, said Ted Nielsen, an addictions counselor at the College of St. Scholastica. They can smoke it or snort it.
Either way, the feeling is good, Nielsen said, probably unlike anything the first-time user has experienced before.
Dennis Cummings, executive director of Duluth Bethel, explained: “Users will describe it the first time they use as like maybe being wrapped in God’s warm blanket.”
That intense feeling of euphoria lasts only a few minutes, Nielsen said, but it’s followed by several hours in which “you feel extreme relaxation and, again, this feeling of harmony that everything’s OK.”
But after it wears off, the user craves a return to that feeling.
‘Chasing that euphoria’
“So, right away the heroin addict is going into withdrawal within a few hours, and they have to find another dose,” Olson said. “So people are chasing that euphoria constantly.”
If the user can’t get heroin, or chooses not to, he or she faces withdrawal.
“Once the heroin wears off the body does not react well,” Nielsen said. “You get muscle aches, nauseated, diarrhea. There’s a huge string of symptoms. I was in detox with several heroin addicts, and they were just all over the place.”
“You don’t die from withdrawal,” Cummings added. “You just wish you would have.”
After a time, he said, heroin users are not so much chasing a high as seeking to avoid withdrawal.
Although withdrawal isn’t fatal, an overdose can be.
“The dangerous part is it affects your breathing sensors,” Delp said. “So as you overdose your breathing stops. … That’s the cause of death with heroin overdoses, respiratory arrest.”
Because the brain first is affected by lack of oxygen, some overdose survivors wind up with brain damage, he added.
Users can be susceptible because heroin strengths vary, Delp said.
“The people I’ve treated for overdoses said they used the same amount as last time but it was a different batch,” he said.
Nielsen said heroin typically isn’t seen on college campuses, but he’s aware of its emerging presence in the larger community. Although never a heroin user, his own past use helps him to know what they’re experiencing.
“When you’re active in addiction, you don’t even really humor the thought that things could be different,” Nielsen said. “That bondage is so strong that even considering something else is just a fairy tale.”