By Rae Harris, Forum Editor
The Vicious Cycle
Samantha Paulus, like many other Long Islanders, has struggled with heroin addiction. The deadly drug also goes by the street names “H” or “smack”, and can be injected, smoked or snorted. When someone uses heroin, the drug crosses the blood-brain barrier and is converted back into morphine, which binds to molecules on opioid receptors- specifically those involved in the perception of pain and reward.
“I was one of those kids who was totally against drugs. Personally, I believed you were for, lack of better terms, a ‘dirt bag’ if you did them,” said Paulus. “Never putting alcohol in the same category [as drugs], I ended up using alcohol to cope with my feelings to deal with emotions that I was never willing to speak about… Then came the day when I realized I was in the grips of heroin.”
Heroin users quickly build up a tolerance and start needing more of the drug to achieve the same kind of high they did when they first used, and to avoid the painful withdrawal symptoms. According to several studies, the brain’s white matter can even deteriorate due to heroin use, which may affect decision-making, the ability to regulate behavior and responses to stressful situations.
This is why heroin is so addictive. Heroin addiction can occur from the first moment a user takes the drug, and many Long Islanders are no stranger to this.
Heroin use among young people on Long Island has skyrocketed in recent years. It’s prevalent in suburban areas and high schools, and it’s not discriminating between the jocks, the bands geeks, the academics or the “popular” girls. From 2009 to 2013, 337 people died from heroin overdoses in Suffolk County alone, more than any other county in New York. Nationwide, about 35 percent of heroin seized by the Drug Enforcement Administration from October 2013 to May 2014 was confiscated in New York.
“Since I’ve been doing this I’ve seen this epidemic get a lot worse, I’ve lost more people to this then I can keep count, the numbers are growing and the education and awareness needs to as well,” said Paul Michael Maffetone, founder of advocacy organization, Michael’s HOPE.
In an effort to fight the epidemic that has been taking over New York State, Governor Andrew Cuomo launched the “Heroin Task Force”. The task force includes healthcare providers, policy advocates, educators, parents and addicts that are in recovery. The goal of the group is to formulate a comprehensive action plan to tackle the epidemic by focusing on expanding awareness, improving prevention efforts, increasing access to treatment and providing support for those in recovery.
The rise of heroin use in New York State is often attributed to the unintentional consequences of a law called iStop that was created in 2013. It tracks prescription medication, in an attempt to avoid drug abuse and to discourage patients from going to multiple different doctors to get prescriptions. However, instead of continuing to use prescription drugs, addicts began seeking out a cheaper and more available alternative, heroin, which is a vicious cycle. Nearly half of young people who use heroin previously abused prescription painkillers before using heroin, according to the National Institute of Drug and Alcohol.
Despite this, the iStop program has proven successful in other ways. Since its implementation in August 2013 to September 2015, the number of “doctor-shoppers” has dropped by 75 percent.
The Road to Recovery
On Long Island, there are only about 300 inpatient beds, despite the 2,716 Long Islanders who were arrested for heroin from 2011 to 2013. Furthermore, there are only 30 inpatient beds in the entirety of Nassau County, yet 38 people died from heroin in the county alone in 2013. All of these facilities typically have long wait-lists.
For an addict seeking help, the first step to a successful recovery is detoxing. This is difficult when facilities, such as the Nassau County University Medical Center, are eliminating their detoxification beds altogether.
Insurance will also not automatically cover the costs of entering a facility for detoxification, because it isn’t deemed medically necessary to be under medical supervision during withdrawal. Withdrawal can be agonizing and dangerous, and in the most severe classes can even cause seizures and cardiovascular issues. When left alone to detox, it’s common for users to start doing drugs again to cope with the symptoms.
Rehabilitation isn’t the only aspect of recovery. Some recovering addicts receive the prescription Suboxone, which contains buprenorphine to combat the user’s chronic pain and naloxone as an opiate blocker. The significance of this pill is that if someone who takes Suboxone relapses on heroin, the high would be blocked and they would go into immediate withdrawal.
Another drug used to combat heroin is Narcan. It reverses the effects of a heroin overdose. It’s legal for a person with no medical experience to administer Narcan to an overdose victim in New York, and the state has even begun providing people with free training sessions on how to administer it. It can be administered by either injection or through a nasal spray form. In Suffolk County, Narcan was administered more than 470 times in 2013 and 2014, and 543 times in 2015.
The problem with Narcan is that when heroin users wake up after being administered the drug, they go into withdrawal because the drug blocks the effects of getting high. After being revived and examined in the hospital, they are released soon after. They are already beginning to show signs of withdrawal, such as stomach pains, shakes and crippling depression. To resist the withdrawal, they’ll often immediately seek drugs and continue the vicious cycle.
Nassau County District Attorney, Madeline Singas, wants to change this. In September 2015, she proposed a new state law that would require any person revived with Narcan to be kept in the hospital for evaluation on a 72-hour hold, and health insurance to pay for this stay.
Instead of allowing a “treatment gap” to exist, as Singas refers to it, anyone who overdoses on heroin in Nassau County can go straight to Maryhaven’s New Hope Crisis Center in Freeport to receive treatment. They can go 24/7 and free of any charge. The average stay of a patient would be 10 to 12 days long.
One of the reasons these overdoses are becoming more common is because a majority of the heroin on Long Island is being laced with a synthetic drug called Fentanyl.
“With Fentanyl being throw in there, it’s scary how many people are dying,” said Tracy Budd, the founder of the North Shore Drug Awareness Advocates.
Fentanyl is up to 50 times more powerful than heroin.
“We’re seeing so many drug overdoses, so many drug fatalities. All of these, or quite often now, all of the heroin is being laced with fentanyl. I am positive that this is contributing to the overdoses that we’re seeing today,” said Suffolk County District Attorney, Thomas J. Spota, at a news conference on April 27.
The Queens District Attorney, Richard Brown, has even called the Long Island Expressway the “Heroin Highway”. The expressway is used to transport heroin from New York City out to Long Island.
Heroin finds its way to New York City in trucks coming up from Mexico, that will park at truck stops or warehouses. It’s then transferred to smaller cars and distributed to Upper Manhattan and the East Coast.
“New York City is the ultimate target for heroin traffickers; it has everything they want — access to thruways along the Northeast, easily concealed stash houses and hidden heroin mills, established transportation routes for distribution and an opioid dependent consumer population,” James Hunt, the acting Special Agent in charge of the Drug Enforcement Agency’s New York Field Division, said.
An Unconventional Route
The mayor of Ithaca, NY, Svante L. Myrick, has a different plan that could help combat the heroin problem in New York. On Feb. 24, 2016, Myrick proposed the creation of the nation’s first safe injection facility, where users could inject drugs under medical supervision. The injection facility would be part of a four-part plan that encompasses Prevention, Treatment, Harm Reduction and Law Enforcement, the injection facility being a part of the “Harm Reduction” pillar.
The safe injection facility would have medical professionals working there who could quickly administer Narcan if a user overdosed, provide clean syringes, prevent diseases such as HIV, Hepatitis B, and Hepatitis C, provide access to treatment programs and encourage users to address other health problems as well.
“This part of the plan is about keeping people alive, helping them get treatment, helping them get better, but in the meantime making sure that they live long enough to get that treatment,” said Svante to 1010 WINS.
In Vancouver, when the city implemented an injection facility, fatal overdoses dropped 35 percent in the community closest to the injection center in just two years and dropped by 9 percent overall.
Stop the Stigma
Rehab and life-saving drugs aside, addiction will never be tackled if the shame associated with it isn’t discussed and combated.
According to the American Society of Addiction Medicine, addiction is a chronic disease of the brain that involves reward, motivation, memory and related circuitry. In fact, several studies have shown that drugs cause chemical and physical changes to the brain that fuel addiction.
Heroin triggers the same dopamine surge in the brain that doing something pleasurable, like eating your favorite food does, but the release of dopamine is more instantaneous and lasts longer. When someone constantly uses drugs, the cells that the dopamine acts on react by numbing their dopamine response, not only to drugs but to pleasure in general. Some of the dopamine receptors even die off.
This means that addicts can have trouble feeling pleasure or happiness, therefore they keep seeking drugs in larger quantities to achieve the same levels of pleasure that they felt before.
Society is coming to terms with the fact that addiction is a disease, as more and more people get tangled in its grip. In fact, in 2013 alone an estimated 21.6 million people in the United States aged 12 or older were classified with substance dependence or abuse.
“This isn’t an individual or just a family disease, this is a community disease. We are in a public health crisis,” says Maffetone.
The Root of the Problem
One of the most important questions asked about drug addiction is “why?”. Why do people get into using drugs in the first place? Is it due to factors like peer pressure or family history?
A reoccurring trend seen is that many people begin using drugs as a way to self-medicate for mental illnesses, such as depression and anxiety. They may be undiagnosed, and not receiving the medical care that could help them cope with their mental illness in a healthy way. As a result, they turn to drugs to numb the pain they feel.
Fifty-one percent of people who have met criteria for a substance abuse disorder also met criteria for a mental disorder at some point of their life, typically preceding the substance abuse disorder.
Former heroin addict, Jordan Stierle, began abusing drugs for those reasons. “Anxiety and depression go away when you pick up heroin/painkillers, but they come back way stronger when the high goes away, and many people don’t know how to deal with that and get stuck in ‘the cycle’,” he said.
Despite the grim nature of the epidemic, many remain hopeful that through avenues of awareness and advocacy, Long Island, New York and the nation as a whole can combat this crisis.
“This isn’t something that can be fixed overnight but through our hard work, passion, dedication and the force of every community getting involved, we can and we will see change. There is hope! Being proactive in the schools to our youths is so important, and opening the minds and eyes of the people in the communities is just as key. We need to get everyone together on this,” Maffetone said.