From The Editors Health

America’s Opioid and Heroin Epidemic

Substance abuse and addiction are destroying a good section of America’s youth.

While it is a big cause for concern in itself, what’s even more distressing is the rate at which the use of contraband substances, even prescription drugs for that matter, has grown in the last ten years, or so.

When it comes to heroin, its use among Americans has increased five times in the last decade, according to a 2017 study conducted by the Columbia University Mailman School of Public Health.

The study also shows an unmistakable connection between prescription opioids and heroin abuse.

It’s no secret that the misuse of opioids has been on the rise ever since these drugs became openly available as prescription medicines in the nineties when pharmaceutical companies shouted out from the rooftops that opioid-based pain relievers were non-addictive.

You don’t have to be a genius to work out that prescription opioid abusers are more likely to become heroin users, and ultimately addicts, than those who have never used or abused them.

Here’s an example of how continued misuse of prescription opioids can trigger a user’s transition to heroin:

Let’s say, your legal access to the drug stops for some reason, and you’re too deep into it to just forget about it; what do you do?

Well, in most cases users start looking for alternative fixes and sources of supply and end up using heroin.

What else could be more easily accessible than street heroin – an affordable and easily available option in most parts of the country?

But that’s just one part of the larger picture.

Heroin use and addiction are not just limited to prescription opioid users; it’s a far bigger problem than that, but before we delve a little bit more into it, let’s first understand the difference between substance abuse and addiction.

Substance Abuse

Substance abuse is, basically, an overwhelming desire to use increasing amounts of one or more substances from time to time, discontinuing which does not really cause any kind of withdrawal symptoms.

This can be anything from legal over-the-counter stuff like cigarettes and alcohol to legal prescription drugs such as methadone, oxycodone, and Zolpidem; from chemicals like inhalants to illegal drugs, including marijuana, meth, cocaine, and HEROIN – potentially, the most lethal of them all.

Drug dependence/addiction

Substance dependence or addiction, on the other hand, is the physical and psychological dependence on a drug for normal day to day functioning.

Discontinuation of the drug leads to withdrawal symptoms, which can range from mild to severe, depending on the drug the user is addicted to, including other factors like the amount of daily consumption and duration of use.

And, trust me, nothing can be more agonizing and devastating, both, mentally and physically, than the withdrawal symptoms of heroin – it truly is a nightmare.

Heroin use and addiction is a huge, complex problem – a clear and present danger in our society – that can’t be given the ostrich treatment.

It’s costing the economy a fortune; it’s related to lots of violent crime; and there’s no denying the fact that it’s destroying the country’s social fabric, not to mention deaths from substance and prescription opioid overdoses.

Drug abuse and addiction, specifically heroin addiction, is an all-encompassing issue with serious repercussions for users, including financial issues, social ostracization, decline in physical, mental and behavioral health, destroyed relationships, broken homes and even death in many cases.

So, what is heroin?

Heroin is an opioid, also known as diamorphine, diacetylmorphine, or morphine diacetate.

On the street, it is referred to by various names, including smack, junk, brown, dope, horse and H, to name a few.

Managing the withdrawal state of heroin addicts requires a different set of drugs compared to those used for alcohol, cocaine and other substance withdrawals.

Naloxone (Narcan)

Sold under the brand name Narcan, among others, Naloxone is an effective medication used in treating heroin withdrawal symptoms and overdose cases.

Naloxone can be injected intravenously or into the muscle, each with a different reaction time, which can be as quick as two minutes when injected intravenously compared to the five minutes it takes to work when injected into the muscle.

It can also be administered subcutaneously (under the skin) or as a nasal spray.


Naloxone is an FDA-approved drug and by virtue of being on the World Health Organization’s List of Essential Medicines, it can be considered safe and effective.

In addition to Narcan, other brand names that Naloxone is sold under include Nalone, Evzio, Prenoxad Injection, Narcanti, and Narcotan, among others.

While Naloxone is a legal prescription drug, rules governing its dispensation by doctors and licensed professionals can vary from state to state.

However, so safe is Naloxone that as many as 37 states in the country allow the over-the-counter purchase of the drug from pharmacists, without the need for a doctor’s prescription.

Again, the safety and efficacy of the drug are evident from the fact that law enforcement agencies in 25 states are legally permitted to carry Naloxone when responding to opioid overdose calls, especially useful when they reach a location before the paramedics do.

It can and does save lives.

Naloxone and other medication are all very good in so far as alleviating the effects of heroin overdose and withdrawal symptoms are concerned, but it’s not the answer to addiction – far from it, in fact.

Self-help recovery

While there are different medicines and treatment for abuse of different substances, when it comes to self-help recovery it’s, more or less, the same general strategies, no matter what the substance in question is.

These strategies also apply to non-substance addictions like self-mutilation, eating disorders, gambling, and sex addiction.

It has been observed that in most cases of substance abuse the problem is not really the problem; it’s what the user, consciously or subconsciously, thinks is the solution to a bigger problem.

If you’re addicted to cutting yourself, for example, it is, in all likelihood, because of some bad feelings, bad situations, or conflicts – basically stuff you don’t want to deal with.

So, you get a razor blade and slash your wrist and voila – instant euphoria, not different from a shot of heroin.

Gone are the feelings of despondency and doom, replaced by a feeling of calm; a sense of power, control, and hopefulness; life becomes much more tolerable.

However, the reinforced feeling that the self-mutilation brings about is short-lived and before you know it all those negative feelings are back, forcing you to repeat the dose.

It’s the same with heroin; the only difference is that when the effects of heroin start to wear off, not only does the negativity return with a vengeance, it also brings with it extreme physical and mental discomfort.

Self-help recovery techniques require you to take a step back and ask yourself some hard questions.

Why am I doing this? Is it solving a problem? What is that problem?
Some people are under the misconception that addicts are weak; well, nothing could be further from the truth.

It’s just a disease that can be controlled, if not treated.

Do you think they just woke up one fine morning and voluntarily decided to become an addict who has to steal every day for a fix?

It could be an underlying problem that can be traced back to your childhood, your teen years, or your adulthood – probably some bad feelings, bad situations, bad relationships, a bleak picture of the future, or whatever.

God, it’s too much; I can’t deal with it; and before you know it you’re cutting yourself, indulging in random and unsafe sex, eating excessively, getting stoned, or getting wasted on heroin.

It all boils down to identifying what it is that you’re trying to cope with and then deciding on what you’re going to do about it in a healthy way so you can eventually let go of your addiction to whatever it is you seek relief in.

Self-inventory plays a huge role in self-help recovery and the first step towards that is to accept that you have a problem – and a big one at that – because all this while you were in denial that you had a problem – a problem not beyond solving.

The level of denial among addicts can be astounding and, more often than not, acceptance does not set in until a major disaster happens.

Continued denial is, generally, a measure of the addict’s desperation to avoid the real pain – the underlying cause of the addiction.

There is no fixed formula, method, or strategy for self-help recovery – it’s a matter of what works for you and what motivates you.

Alright, so it’s easier said than done, but the key is to be motivated enough and not be in denial.

The desire to rehabilitate should come from within; it’s not something that can be force-fed.

However, it is still something that can be encouraged with the right kind of professional help, peer support and, most importantly, a lot of patience, love and understanding on the home front.

Trafficking and distribution

How does heroin reach the U.S. borders and eventually the nation’s streets? How much smack are we talking about?

There’s a common misconception that most of the heroin coming into the U.S. is being trafficked through Central America’s “Northern Triangle” region.

Assistant Secretary of State for International Narcotics Control and Law Enforcement Affairs William Brownfield estimates that 90-94 percent of all heroin consumed in the United States comes from Mexico, about 2 to 4 percent from Columbia, while the remaining 4 to 6 percent comes from Asia – a large part of it originating in Afghanistan.


Although Afghanistan doesn’t have much of a say in the US heroin scene, it is responsible for most of the drug consumed elsewhere in the world, producing about 80 percent of the world’s heroin.

After the heroin finds its way into the U.S., how does it trickle down to street level dealers selling the H in nickel bags?

Although the method of illegal drug sales and distribution follows a pretty much generic pattern involving retail level distributors and wholesale distributors, it can be extremely complex when applied to specific distribution groups, according to a study.

The holders, transporters, mules, deliverers, counters, lookouts, backups, muscle, and whatever else it takes, make up the distribution network that operates like a well-oiled machine to make the poison available on street corners, neighborhoods and around educational institutions and wherever else it can be pedaled.

This is big business we’re talking about and, like it or not, it seems like it’s not going to go away anytime soon.

How do other countries deal with this menace?

The U.S. is one of the smartest and strongest countries in the world, yet you have drug dealers running rampant in the cities and towns, killing children and destroying families.

It’s the United States of America, for God’s sake!

Despite the efforts of the DEA and other law enforcement agencies, the drug menace continues unabated in the U.S.

How come countries like China, Saudi Arabia, Thailand, and Singapore, among others, are better off when it comes to controlling drugs and addiction?

The answer to that is simple; their drug laws are strict enough to work as effective deterrents.

In short, put the fear of God in the hearts of perpetrators, and you’ll have better control of the drug situation.

In China, if you are caught with drugs you’re made to attend a state-run drug rehab facility, with some drug crimes even attracting the death penalty.

Saudi Arabia is among the strictest of countries when it comes to drug laws; selling drugs in the Kingdom almost always attracts the death penalty.


Even alcohol is illegal in this Islamic nation and possession or use of alcohol or drugs is punishable by public flogging, financial penalties, lengthy imprisonment, or death.

In Thailand, traffickers can get the death penalty, while users are generally required to go through a government-sponsored mandatory rehab program.

In Singapore, even if you are caught with a relatively small amount of drugs, the police will, by default, treat you as a seller, which, if proved, will lead to the death sentence.

What more can be done in the U.S?

The DEA is constantly devising new plans and strategies to curb the influx of heroin and its distribution networks working in the country.

With more than 90 percent of heroin coming in from Mexico, the DEA, of late, has included more technology in its battle against Mexican heroin, using drone and geo-location technologies to identify Mexican farms cultivating poppy – the raw material for producing heroin.

However, not much is expected from this endeavor because attacking the problem in one location causes a balloon effect, meaning the cultivation shifts to another area, former DEA official Mike Vigil told NPR’s Lulu Garcia-Navarro, as recently as April, this year.

This is one of the reasons why Donald Trump is pushing so hard for the wall.

Cutting the proverbial head of the snake sounds like the ideal solution, but what do you do with a monster of epic proportions with several heads?

This is where the common man – the concerned citizen – can have a role to play, even if it’s only by way of creating awareness and making contributions to non-profit organizations who are genuinely working towards a common cause – a drug-free America.

As far as lawmakers are concerned, it’s about time they took a leaf out of the China or Saudi Arabia book, and put strict legislation in place that can serve as a powerful deterrent.

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