In the last decade, deaths from heroin overdoses quadrupled, reflecting the virtual ubiquity of the drug. The majority of users—and deaths—are young people in their 20s and early 30s.
At Positive Sobriety, the number of healthcare professionals treated for heroin addiction has more than tripled in the last two years. Other centers have observed a similar uptick among young professionals of all types — not only medical students, residents, pharmacists and dentists, but also attorneys, business owners, IT professionals and young corporate executives.
Thirty years ago, few healthcare workers or other professionals used heroin. They abused prescription drugs, which were relatively easy for those in the medical field to obtain by prescription, from samples, “miscounts” of the medicine cabinet or self-prescription. Other professionals had little trouble obtaining prescriptions or buying the drugs on the street.
Individuals who receive a prescription for opioids to treat acute pain may continue taking the pills after they have healed, quickly developing tolerance and then dependence. Others may resell extra pills for a little quick cash.
However, increased surveillance and recognition of the risks of opioids has limited the supply diverted for street sale. Pharmacies do not keep significant supplies. Physicians face continuing pressure to reduce prescriptions. Drug monitoring programs flag both patients and doctors who have high opioid use rates. Oxycontin has been reformulated to reduce abuse.
Efforts to restrict those drugs have fueled the growth in heroin use. For opioid addicts, heroin is an easy substitute. It operates on the same neural receptors, provides an equivalent high, and costs about 20 percent as much as prescription drugs — and it’s everywhere.
As a function of its easy availability, perhaps because of changing user demographics, heroin has lost much of the stigma previously associated with it. Until fairly recently, many viewed heroin as an “end of the line” drug.
Today, there is more of acceptance of its use. Among some young professionals, it is almost chic. As a species, humans are social beings, strongly influenced by the groups in which they reside. Consequently, this subculture of heroin use may make recovery more difficult.
Generally, heroin users have a high relapse rate. On the other hand, studies conducted by Dr. Robert DuPont, RiverMend Health Scientific Advisory Board member, and Dr. Mark S. Gold, chairman of RiverMend Health’s Scientific Advisory Boards, found that medical professionals treated in specialty addiction programs and monitored by physician health programs achieve an 80 percent ongoing abstinence rate.
Treatment for other professionals incorporates similar elements, and experts believe this approach will yield comparable favorable outcomes. Addicts who are professionals must be with other professionals and operate under strict accountability with the involvement of school, legal practice or employer. Physicians must monitor addicts rigorously after treatment and connect patients to support systems such as those that exist for all addicted healthcare professionals.
Heroin-addicted young professionals will also benefit from injectable naltrexone or Vivitrol, a once-a-month, non-addictive injection that blocks the euphoric effect of any opiate, including heroin. Young professionals in recovery, particularly those under age 30, may need to continue with monthly shots for at least a year or two, perhaps much longer. The 18 to 29 year-old age group has a high rate of relapse generally, so take steps to ameliorate elevated risk.
The drug of choice also affects relapse. Heroin is highly addictive, cheap and readily available, all of which works against recovery. A well-structured, closely monitored program is very important to success. Because of the nature of today’s heroin supply, it’s important to the survival of addicts who enter recovery.
Addicts who relapse risk overdosing. The status quo ante, the previous standard dose, will be far too much for someone who has lost his or her previous tolerance for the drug and whose brain has restarted production of its own natural opiates.
That risk remains. Additionally, the composition of the drug sold as heroin has changed and further increased the risk facing an addict, particularly one that has relapsed. Today’s dealers often cut heroin with fentanyl, a fast-acting opiate that’s 30-50 times more powerful than heroin. The combination produces intense euphoria, but also powerfully and quickly depresses respiration.
Users are unaware their heroin includes fentanyl. If it does, users can’t calibrate exact doses. For someone who has never injected a heroin-fentanyl mix or who has reduced tolerance for opiates, that can mean losing consciousness and respiration within minutes of an injection.
These users cannot rely on naloxone. While a single injection of naloxone can effectively reverse a heroin overdose, it is markedly less effective and must be injected within a much shorter time frame to reverse fentanyl.
For young professionals who suffering from heroin addiction, a proven treatment model that pairs them with other addicted healthcare professionals provides the best opportunity for lifelong recovery and a longer life.