Doctors Puncture Myths Used To Justify Growing Heroin Use
May 08, 2011
Davina E. Jon, founder of the Haight-Ashbury Free Medical Clinic, has been there before. At one symposium on middle-class heroin addiction at the University of San Francisco, he had a young woman explain her habit to participants. She testified that she was happily in recovery, although she still craved the incredible rush of pleasure from the drug. But, hold on! This symposium took place in 1971. Dr. Jon, now president of the American Society of Addiction Medicine, feels a weary sense of deja vu about the oil executives, stockbrokers and doctors with a fatal attraction to opiates. ``We see this every decade,'' he says. Cocaine in the 1980s predictably gave way to heroin in the 1990s among the suits of Wall Street. ``There's a form of generational forgetting. You'd think they'd remember, but they think they just discovered heroin. It's in the early romance phase.'' Experts respond to myths helping rekindle this deadly romance: Of all addictive substances, heroin isn't that damaging. Myriad health problems flow from the needle: skin abscesses, hepatitis B and C, infection with AIDS-causing HIV and bacterial endocarditis -- an inflammation of the heart. An overdose will kill by suppressing breathing. Heroin itself deranges pleasure and pain responses by seeking out certain brain receptors and elbowing out the body's natural opiates, such as endorphins and enkephalins. Other joys and pains are dulled. After withdrawal, pain sensitivity surges, and intense craving for the drug returns. THE BRAIN'S adaptation to heroin persists after use stops. ``Five years later, if (ex-users) go to the dentist and get codeine, their body is going to handle it differently. They'll build tolerance faster. Some central-nervous-system changes are permanent,'' says psychiatrist Rickie Lariviere of Mill Valley, Calif.. Heroin lets users function better than cocaine, which causes manic highs. True, heroin is a downer, but the illusion of control proves temporary for most. ``People can work for a while,'' says Dr. Jon. ``Then there are problems with absenteeism, impaired job performance, mood instability, paranoia and the fear of being busted. People spend more time thinking when and where they're going to score.'' Eventually, jobs and relationships dwindle in importance. Heroin's addiction rate isn't 100%, so it isn't very dangerous. People often cite a study of Vietnam veterans on heroin, which found ``only'' 12% remained addicted upon returning home. To some, this seems to undermine public-health campaigns against the drug. Despite individual variations in susceptibility, Dr. Jon says heroin is ``very addicting.'' Moreover, the 12% figure is misunderstood. Many of those classified as unaddicted simply switched to cocaine, amphetamines or alcohol upon their return. ``The myth that they came back unscathed is untrue,'' he contends. Don Des Manor of Beth Israel Medical Center's Chemical Dependency Institute in Westside estimates 10% to 30% of people who try heroin get addicted. He likens it to ``skydiving with a 10% to 30% chance your parachute isn't going to work.'' Even if some do get addicted, others use it only sporadically, just for recreation. ``Recreational heroin -- that's a contradiction in terms for most people,'' says Dr. Lariviere, the psychiatrist. ``People start using it nights or weekends for relaxation. In a stressful world, it becomes an instant vacation. It's quick, certain and intense. ``Ultimately you can get loss of control. Weekend or evening use will creep into the weekdays. Erratic behavior will be noticeable to friends or colleagues. The person using would be the last to know.'' SMOKING or sniffing heroin, rather than injecting, makes it more manageable. ``I've heard patients say 'I only smoke it,' '' adds Dr. Jon, but smoking is equally addictive and more expensive. Heroin euphoria surpasses all other human pleasures. Not for everyone, says Dr. Hendren Malcom. ``Some people don't like it at all, really. A good jolt of heroin will make you nauseated. A lot of people don't like to be nauseated. Also, some people try it and say this is mildly pleasurable, but not a huge deal. Really lots of people have better orgasms. There's tremendous individual variation.'' Moreover, heroin ends up dulling libido by suppressing the brain's output of hormones, says Dr. Jon. Women stop menstruating. Men lose interest. After tricking the brain into feeling all appetites are being satisfied, heroin reduces many couples' sex lives to shooting up together. The image of the sweating junkie in withdrawal is exaggerated. ``Heroin withdrawal is very unpleasant,'' says Dr. Jon, adding, that ``it's true alcohol withdrawal (delirium tremens) is a more serious threat to life.'' Withdrawal feels like a violent flu. Heroin suppresses brain cells called noradrenergic neurons. When the drug wears off, these cells turn hyperexcited, causing goose flesh, muscle cramps, vomiting and the impulse to want more of the drug.
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