Chapter 3
Narcotic Addiction and Abuse

Americans, descendants of rebels and explorers, often push themselves to the edge in search for the ultimate challenge or reward. But in the never ending quest to experience it all, some have pushed too far. Those who have chosen to try narcotics for thrills have hitched their lives to the most addicting group of drugs in the world.

An addiction is a complex condition that results in an emotional and physical inability to avoid drug use. Eventually, an addict is compelled to continue taking the drug, even when met head-on with harmful consequences. Addiction affects a person's body as well as his or her mind.

Narcotics' chemical effects on the brain make them so addicting. Sections of the brain and spinal cord contain cells loaded with opiate receptors, structures that normally bind to the body's own painkilling chemicals. When these natural chemicals bind to the receptors, pain signals traveling to the brain are diminished. Because the physical structures of the natural chemicals are very similar to the structures of narcotics, narcotics are also capable of binding to cells' receptors for natural painkillers.

But once bound, narcotics do more than just block some of the pain. They also stimulate an area of the brain called the pleasure center, giving a rush of euphoria and several hours of blissful stupor. In some of the people who experiment with narcotics, these sensations feel better than anything they have experienced before.

The Price of Pleasure

The pleasures of narcotics are quickly clouded with problems. In a very short time, a user finds that the small dose that originally produced complete happiness is no longer effective. This change occurs because the presence of narcotics in the brain causes it to stop using its own built-in pain-blocking mechanisms. When these mechanisms break down, narcotics lose some of their effectiveness. As a result, the user needs increasingly larger doses of narcotic to experience the euphoria felt earlier on a much lower dose. This condition is called habituation or tolerance because it takes more of the drug to get high. Habituated users may take dangerously high doses of narcotics in an effort to re-create the pleasurable experiences they had earlier. Abusers taking large, frequent doses of narcotics find that their habits quickly become expensive, and when money is lacking, some turn to criminal acts to get cash. Some addicts steal from friends and family, commit robbery, or even prostitute themselves to support their habits.

A young heroin addict explains how her drug habit led her to steal from her family:

I was 16 when I first snorted heroin. I was in my car and my cousin just happened to have some on him. I was like "Let me try, let me try," and he did. But he only gave me a very tiny amount, so it really didn't even do much.

When I was 17 . . . (a boy had) heroin. I did the whole bag and I was really high. I threw up and all that, but it was great. It was just the most wonderful feeling. That's when it started and I was hooked until I was 21. I had no idea how addictive it was.

Within three months, I was doing it every day. I was working at a car wash and I blew most of my money on the heroin. Then I started stealing from my parents. I wrote out checks of theirs to myself. I stole my mom's jewelry. I'd take anything around the house that was of value and pawn it off. I stole equipment from my little brother's band, and that's why his band broke up. I never tried prostitution or anything like that.²⁸

Who Needs Help?

Concerned families, friends, and professionals want to help a person who is experimenting with narcotics. However, narcotic use is not always easy to identify. Even medical professionals have guidelines they follow to help them make a determination. One red flag is constricted pupils and sensitivity to light. The person may even appear intoxicated or sleepy. Teen Challenge, a source of help for young people dealing with heroin, says:

When someone has had a sufficient dosage, or from an hour to two hours after injecting "smack" (heroin) he might "nod out" (literally fall in and out of a sleeping state) in the middle of a conversation or even while driving. Addicts refer to this as being "on the nod." It is not uncommon for heroin addicts to "nod out" while smoking a cigarette and subsequently suffer burns on their fingers where they were holding the cigarette. In the same way they often burn holes in their clothing or in the furniture where they are sitting or lying.²⁹

A Day in the Life

John Patten, writing for Packet Online, interviewed a young narcotic addict and recorded his story.

Each and every day, a 20-year-old East Windsor resident we'll call Kent wakes up with a mission—to go to Trenton and buy enough heroin to get through the day. It's a mission that has ruled his life for most of the last three years, and requires several hours each day. If he doesn't get the heroin, he will get sick before the sun goes down, convulsing in cold sweats.

Kent said he was intrigued with the idea of trying heroin after watching movies like "Trainspotting" and "The Basketball Diaries." He remembers the Friday night in May 1997, when he snorted his first line of heroin and began a descent into the nightmare of heroin use.

"The 'rush' was so good, I went back to it," he said.

As Kent and his girlfriend continued their use—she was shooting up, while he snorted it—their tolerance to the drug grew. One tiny "bag" of heroin that cost $15 would get them both high once or twice when they started, but just two months later the same size bag would barely be enough to give him a "buzz." "Now, I need to do two bags in a . . . shot to get the same effect. If I want to get high, I need to use three bags."

Now firmly in the clutches of the drug, Kent spends the better part of every day riding buses (his driver's license was suspended following a conviction for possession) to the "drug markets" in Trenton. After making his buy, he finds a public restroom—a donut shop or coffee shop—and shoots up. That's Kent's life, seven days a week.

"The only thing this disease wants is to make you dead," Kent said. "Age, race and color don't matter—nobody is immune."

Once a drug user is identified, a medical professional may need to determine addiction. Whereas a narcotic abuser may use occasionally, an addict has developed a dependence on narcotics. Narcotic addiction should be suspected if an individual displays certain behaviors for a month or longer. For example, if someone starts missing important activities, such as participation in sports or attendance in school, addiction should be suspected. One telltale sign that differentiates addiction from abuse is the need for increasingly larger doses of the drug, or continued use over a longer period of time than originally intended. For example, a person who had planned to try a narcotic only one time may find that they keep coming back to the drug again and again. The inability to cut down on the amount of drug being used, a sign of habituation, is also an indicator.

Another symptom of addiction is continued use of the drug despite the knowledge that it will cause negative consequences, such as a conflict with the family or poor grades. While admitting that narcotics have caused her numerous problems, one woman says she continues to use them. She explains, "The first opiate I ever took was codeine. . . . It made me feel right for the first time in my life. Codeine was a revelation, and I've been an opiate user ever since. . . . Opiates have caused me lots of trouble."³⁰

Withdrawal Syndrome:"Getting Sick"

Once a person's body has become habituated to narcotics, it is very difficult to stop using the drugs. Without the narcotic, the user experiences an unpleasant condition called withdrawal or "getting sick." Withdrawal, which has both physical and psychological components, refers to a set of symptoms that occur after a person stops using an addictive drug. Withdrawal symptoms usually appear four to six hours after the last dose. Initial physical symptoms vary from one person to the next, but in many people they mimic a bad case of the flu, and include muscle aches, tearing of the eyes, runny nose, sweating, and yawning. Early psychological symptoms vary, but include anxiety and jitters.

Within twelve to fourteen hours, the symptoms begin to change from flulike to more severe. The pupils of the eyes become dilated, appetite diminishes, tremors pass through the body, aches get worse, and gooseflesh appears. This gooseflesh, normally associated with the feeling of being cold, may be the origin of the term cold turkey which is used to describe the sudden cessation of drug use. Feelings of sadness and depression may occur along with anxiety.

After fourteen hours, the addict feels tired and irritable. Insomnia, weakness, nausea, vomiting, chills, and muscle aches and spasms may still be present. Muscle spasms in the legs are believed to have led to the term kick the habit, which refers to the act of getting off of drugs. These withdrawal symptoms can persist for seven to ten days. Eventually these acute symptoms subside, and the addict moves into a phase of extended abstinence that causes a mild increase in blood pressure, body temperature, and respiration, as well as feelings of sadness and mild anxiety. Even after thirty weeks or more, the addict may still be experiencing some of these physical symptoms.

The symptoms of withdrawal are due to the lack of normal painkilling chemicals in the brain. Without these chemicals, it is impossible to experience relaxation, pleasure, or contentment. The brain does not start remaking its normal chemicals for several weeks or even months after drug use has ended. That explains why the addict feels sadness, pain, misery, and loneliness for so long. Nothing is interesting or entertaining, nothing feels or tastes good, and nothing brings pleasure. At this low point, the only way an addict can experience pleasure is through heroin, and the desire for the drug is strong.

A heroin addict describes his withdrawal experience to a friend who is considering trying heroin:

First thing that hits is an almost incessant yawning, and watery eyes . . . some flu like sniffles, maybe sneezing . . . then sweats and chills chills . . . lotsa chills. . . . But this is nothing . . . just a little prelude of the fun to come. . . .

You basically feel like you want to die for the first three days, you throw up, your bowels ache and burn. . . . Muscle's ache . . . lower back knots.

Severe detoxing of opioids, one may have uncontrollable shaking of the legs and thrashing due to severe anxiety . . . and cramping. . . . Sleep is impossible at first no position is comfortable, minutes seems like hours . . . anxiety consumes you . . . and you want to scream. . . . Panic, consumes you. . . .

Long Hot Showers (saviors) in the middle of the night give minor relief . . . but that minor relief seems at that second like it is all that is keeping you alive . . . and so you really appreciate it and you want to remember all of it . . . so that you do not do it again. . . .

Sleep is Painful for a long while & after. . . . You have unbelievable night mares . . . that stuns you with their impact on your psyche . . . and . . . endless headaches at this point . . . deep in your brain it seems. . . . Tylenol helps. . . .

What it is like to be very hungry and think of food . . . your mouth salivates for food, a conditioned response . . . heroin also conditions responses in you. . . . It simply becomes part of you. . . . It is an appetite you have now . . . and anything can set it off.³¹

High Quality, Low Prices

The U.S. Drug Enforcement Administration keeps track of drug use and the status of drugs across the United States. In 2001, the most recent year for which statistics are available, it reported that heroin is still one of the two "primary drugs of abuse in the state of Massachusetts. . . . High-quality heroin is available from gram to kilogram quantities throughout the state. . . . High-quality heroin is purchased in pure form, then cut [mixed with other ingredients] and repackaged for resale. Heroin distribution and use continues to be spread throughout the state, with extremely low wholesale/retail prices and purity levels routinely exceeding 60%. Abuse remains widespread, with continued reports of heroin overdose deaths and incidences occurring throughout the state."

The story is similar in other states. In California, the heroin is of very good quality and is smuggled into the state via Mexico. DEA agents explain: "The increased availability of high-purity heroin, which can effectively be snorted, has given rise to a new, younger user population. While avoiding the stigma of needle use, this group is ingesting larger quantities of the drug and, according to drug treatment specialists, progressing more quickly toward addiction."

Popular Drugs

As painful as withdrawal can be, it is not the most dangerous aspect of illegal narcotic use. Emergency room visits resulting from heroin overdoses have been increasingly common. In one Washington community, the number of opiate-related deaths increased by 140 percent between 1990 and 1999, the last year for which statistics are available. During the same time period, the community's population grew by only 11 percent. Opiate-related deaths occurred primarily in men between the ages of twenty-five and fifty-four.

In 2001 DAWN, the Drug Abuse Warning Network, surveyed emergency departments in cities across the United States. Although patterns of illegal drug use vary greatly from one city to another, their research showed that heroin is the second most commonly reported drug in Emergency Departments, accounting for forty-four out of every one hundred thousand visits. One city in particular, Detroit, has experienced an increase in heroin over-doses. The Community Epidemiology Work Group, a network of researchers from twenty metropolitan areas who follow trends in drug use, states in December 2001 that reports of heroin by emergency room doctors "has increased significantly in seven cities, including Detroit. . . . Heroin was responsible for 32 percent of drug-related admissions in Detroit hospitals, nearly half of all admissions statewide."³²

A Dangerous Habit

People who are addicted to narcotics and many other drugs suffer long-term health problems. Users tend to be so focused on their drug they forget to take care of themselves. Consequently, they often eat poorly and lose weight. They also suffer from long-term constipation. Since opiates cause slow, shallow breathing, addicts do not take in enough oxygen to maintain normal levels in their blood. They experience long periods of hypoxia, or low oxygen. In the brain, lack of adequate oxygen can cause irreversible damage to neurons.

Heroin users who inject the drug face even more risks. Long-term abuse by injection can lead to scarred or collapsed veins and infections of blood vessels and the skin. Sharing injection paraphernalia has serious consequences because needles are an easy way to spread diseases carried in the blood. If a person who has a bloodborne disease shares a needle with someone else, the disease can be passed along to the second user. Diseases carried in the blood such as hepatitis C and AIDS can destroy a user's health. Intravenous drug use is responsible for one-third of all new cases of AIDS and one-half of new cases of hepatitis C in the United States. Once these conditions are contracted, they can then be passed on to sexual partners and to children.

Heroin addicts also face danger because it is impossible for them to know the ingredients in their product. The quality of legal drugs is monitored by the Food and Drug Administration. However, illegal drug dealers make no promises about content or quality. As a result, users have no idea what kind of contaminants the heroin will contain, and they never know how much pure heroin they are getting in a purchase.

Heroin is prepared in unsupervised labs, then sold and resold by several different retailers. Each seller dilutes or "cuts" the drug to increase their profits. Any white powder can be used to dilute the original batch. Dry milk, talc, starch, and sugar work well, as well as poisons like strychnine. Strychnine causes the heart rate to increase, a response that naive purchasers may attribute to the heroin. Any contaminant poses problems when dissolved with the heroin and injected into the body. Some clog blood vessels while others damage vital organs like the liver or kidneys. Contaminants in heroin that damage the body are referred to as "bad dope."

On Monday, a customer may buy a packet of heroin that is only 10 percent heroin; 90 percent of it is starch. However, on Tuesday the same customer might purchase heroin that is 30 percent pure. Simply by snorting the same quantity on these two occasions, the user unwittingly gets a much stronger dose on Tuesday than on Monday. Large doses of heroin cause the respiratory systemto stop; as a result, the user quits breathing. About 1 percent of heroin addicts die each year from accidental overdose.

The purity of today's heroin poses another problem. Currently, heroin on the streets is the purest it has ever been, averaging about 40 percent. It is so pure that it does not have to be injected: It can produce a high and a rush by being sniffed or smoked. Without the stigma of the needle, heroin appeals to a larger group of people than ever before. A Worcester, Massachusetts, newspaper reports that the emergency room there sees a lot of heroin overdoses. "A lot more heroin users are snorting the drug as opposed to injecting it. When heroin is very pure and snorted, it causes a bad reaction. . . . many users are not accustomed to the pure heroin sold on the streets. . . . Users who get out of jail after a short hiatus from the drug are in for a surprise."³³

For these reasons, overdoses can happen to novices or longtime heroin users. Will, an addict, tells about the death of his friend Harry from an overdose of heroin:

Feeling fine, partying on, and as usual, talking the sort of crap to each other that only a 15 year friendship brings. We had the dope, and I nodded off. I woke up and Tom was dead. I knew as soon as I saw his grey face that this was true, but I'd revived him in the past, so I tried to now. It didn't work. The ambulance confirmed it. I remember giving him mouth-to-mouth and hearing a gurgling in his lungs.

Why I'm still alive, I don't know, or only God knows, if you prefer. I can't say I would never take those drugs, if I had the time again, but I would do anything to bring Tom back, only I can't.³⁴

Risks to Babies Born of Addicted Mothers

In addition to harming the user, narcotic use during pregnancy exposes an unborn baby to many additional risks. Any opiates ingested by the mother also enter the baby's bloodstream. As a result, babies of narcotic users are at higher than normal risks of problems. The most commonly reported complication is lower-than-normal birth weight. Other dangers are risk of death in the uterus, spontaneous abortion, and death during or shortly after delivery.

Babies who are exposed to high levels of narcotics in the uterus develop a physical dependence on them. Therefore, babies born to narcotic addicts are addicted at birth. As a result, they undergo withdrawal symptoms for several days. A baby in withdrawal is very irritable and has a high-pitched cry and tremors. It breathes faster than normal, sweats, vomits, and may experience diarrhea, fever, and seizures.

The experience of caring for an addicted infant can be heartbreaking. In an interview with a young addict, a reporter reveals some of the complications of narcotic use during pregnancy.

Marie gave birth to her first child just a week ago. But when the 29-year-old mother went home two days later . . . she had to leave her new daughter behind.

Like her mother, the infant is addicted to opiates.

A Lifetime of Addiction

In the Schaffer Drug Library's Consumer's Union Report on Licit and Illicit Drugs written in 1972, Edward M. Brecher reviews some of the historical evidence supporting claims of an eminent surgeon's morphine addiction. William Stewart Halsted (1852–1922), known as the father of modern surgery, was one of the founders of the Johns Hopkins medical center. At his death at the age of seventy, he was honored for his many contributions to medicine. Halsted was surgeon in chief of Johns Hopkins University School of Medicine. In that position, he pioneered a breakthrough operation for breast cancer, the mastectomy. His keen insight into the need for good hygiene and sterile conditions in the operating room brought about the use of rubber gloves in hospitals. Halsted also developed an improved technique for blood transfusion. His creation of the Halsted School of Surgery still provides residents with the training they need to become surgeons.

Yet, decades after his death, it was revealed that the doctor suffered from addiction to morphine for much of his adult life. Halsted's addiction had so little effect on his work that he was able to keep it a secret. His problems probably began just like those of countless others who were following the correct medical protocol of his day for using morphine. At one time, this innovative surgeon was suffering from an addiction to cocaine, a highly stimulating drug. Morphine was advertised as a safe, nonaddictive drug that could be used to treat addiction to other drugs. Halsted tried it, and successfully weaned himself off of cocaine. However, he was never able to escape his daily fix of morphine.

Halsted's addiction, which would be scandalous by today's standards, was very understandable in his time. It was not uncommon for medical professionals to experiment on themselves with new drugs when they were introduced to the market. In the process of educating himself about medications that might benefit his patients, he learned firsthand about the addictive powers of the opiates.

. . . Marie passed her drug habit on to the child in her womb and now medical staff must care for the baby as it goes through the painful throes of withdrawal.

The little girl cries more than most normal babies, a high-pitched fretful wail. She has trouble sleeping and gets the sweats. Sometimes when Marie pulls at her daughter's tiny hands, they remain clenched and rigid—a typical symptom of an addicted infant.

Initially, nurses will give the baby increasing doses of drugs, such as [a solution] of opium, to lessen the physical impact of withdrawal. Then they will slowly reduce the level of drugs until her small body has been weaned. The process could take two months.³⁵

To prevent some of these problems, an addicted mother can switch to a drug called methadone during her last six weeks of pregnancy. Once on methadone, she can reduce her drug intake each day. By lowering narcotics levels in her own blood, a mother also lowers them in the fetal blood. Babies born with very low levels of narcotics suffer much fewer problems than those born with high levels.

The problems that opiates pose to individuals, their families, and their friends are life changing. Doctors agree that the only sure way to avoid opiate addiction is to never try narcotics. However, help is available to anyone who needs it, no matter how serious their addiction.