Paths to Heroin Addiction and New Measures of Prevention

There are many roads that lead toward addiction. The danger is believing addiction, especially opioid and heroin addiction, can’t and won’t happen to you or someone you know.

“Anyone has the potential to become addicted to opiates, and that is why rates of addiction for these drugs have taken off,” says Stephanie Calmes, Clinical Manager of Alcohol and Other Drugs (AOD) for Harbor. “They may have previously thought ‘Addiction doesn’t run in my family, I’m well-to-do, this doesn’t happen in my neighborhood.’ Certainly, no one sets out to be an addict, no one says ‘I want to grow up and use drugs.’”

Addiction at its simplest is a disease. According to the National Institute on Drug Abuse, addiction can be hereditary, and can be triggered by environmental conditions and behavior. In the same way environmental and behavioral conditions can factor into cancer risk, in the case of heroin and opioid addiction, environment also plays a key role.

“One thing that’s kind of unique to opiate addiction is that people usually don’t start off with using heroin. Often it starts with someone taking an opioid prescription for a medical issue and they transition to heroin over time,” says Calmes.

Opioid painkillers are narcotics, such as oxycodone, morphine and fentanyl, and are prescribed for any number of chronic or short-term conditions. A patient may have just had surgery, or could be experiencing prolonged pain from an old injury. However, not everyone who starts off taking an opioid becomes addicted, and not everyone prescribed opioids abuses them.

“Any narcotic is potentially habit forming, and they’re habit forming because, depending on the intensity, it’s going to provide you that pain relieving response,” says Calmes. The added danger becomes the length of time a person is on the prescription and how they’re taking it.

“The difference is if they’re taking those medications as prescribed and being weaned off of it versus the addict that is abusing the drugs, taking more than prescribed or with other things. That’s when it crosses over into an addiction,” adds Theresa Butler, Executive Director, Clinical Services for Harbor.

Do No Harm

According to the National Institute on Drug Abuse, the number of prescriptions for opioids nationwide escalated from around 76 million in 1991 to nearly 207 million in 2013. Realizing the impact opioid addiction was having on the population, government and health officials worked together to set opioid prescription guidelines. In Ohio, policymakers began implementing their strategic plans to address addiction in 2011, which helped decrease the rate of opioid and sedative prescribing.

Some of those strategies to minimize abuse are being seen inside ProMedica Emergency Departments. Long seen as the front line for patients seeking opioids, ERs now have methods to identify patients who could be at risk for addiction or dependency.

“We have a method for flagging patients, where we explain what we’re doing and how we’re trying to protect them from this epidemic,” says Jeff Ford, MD, a ProMedica emergency room physician. Ford and his colleagues follow a “pain protocol,” where each patient in pain is assessed according to their number of recent ER visits, medical history, prescription history and other factors. In addition to hospital-specific procedures, state-wide, all opiate and benzodiazepine prescriptions filled by all patients is available to any prescriber through a system known as OARRS (the Ohio Automated Rx Reporting System). This system allows physicians to see, for example, whether a patient has an active prescription, even in a different Ohio city. If the patient is identified as being at risk for dependency or suspected of addiction, the physician has the task of raising his or her concerns.

“We try to make it clear they’re not being singled out. We’re trying to be consistent,” says Dr. Ford. “The goal is to help that patient, and we owe them a respectful explanation. This is somebody’s family member. This is a real person in pain, but we can’t give them what they want just because they want it.  We have a responsibility to weigh the risks and benefits of any treatment and try to do what’s right.”

A medical professional’s mission is to heal their patient first and foremost, so rather than perpetuating the cycle of addiction, patients are referred to a number of addiction specialists, as well as pain management specialists. As a general rule, ERs don’t prescribe narcotics for those whose chief complaints are chronic pain, yet people still come in seeking medications.

“That’s not the exception, that’s the rule,” says Dr. Ford. And they’re not looking to get high or sell them—they’re just looking to feel better. Some of these folks are habituated, and that habit can affect their pain tolerance.”

The trouble with pain is it can be chronic for some, and when someone dependent on opioids comes in with an unrelated injury, a new facet is added to the way professionals handle treatment.

“What’s challenging is when patients come in with 10 years of regular prescription opiate use, and they have a minor injury that doesn’t appear that painful to other people.  Sometimes taking opiates for years can actually lower their pain tolerance.  These patients can be challenging. Their pain is real, and every case is a little different. Medicine is not ‘cookie-cutter.’”

While each patient isn’t a textbook case, what doctors can do is refer them to a specialist to manage their chronic pain. This specialist’s main goal is to address the pain in a way that finds the patient relief, while also weaning them off their current medication.

“The doctors are trying to do the right thing. They’re not abandoning these patients, but sometimes the patients are finding it their own way.”

The End of the Road

“Heroin is the end of the road, when it comes to opiate use. They may start using heroin because they are no longer prescribed narcotics and it’s a lot cheaper to get heroin. Many people cannot afford to keep buying narcotic painkillers, and at that point, they’re using just to not be ‘sick’,” Calmes says.

A number of factors are said to have contributed to the growing opioid and heroin addiction epidemic. A report by the National Institute on Drug Abuse points to an increase in the availability of prescriptions written and dispensed, as well as a society more willing to accept medications to treat various ailments.

“There’s been a lot of experimentation,” says Butler. “They don’t have that fear of reaching into a bowl of pills not knowing what they’re taking. That fear of drugs isn’t present like it was in the past. People were not realizing how strong opioids are and how quickly they could become addicted to it, and that group 5 years ago switched over to heroin.”

“One thing that always amazes me is that people often take what they’re given by a doctor without asking any questions about it, and they become addicted because they had no idea of the risks,” adds Calmes. She says one key to attacking soaring heroin and opioid addiction rates is being a mindful consumer and speaking up. Advocating for yourself can make all the difference in your wellbeing and in preventing addiction.

“Ask ‘Is this medication necessary, how long should I take and how much, what should I look out for?’ There are a lot of things people should be asking their doctors but they aren’t, and they assume the doctor will tell them what they need to know. Get the right info and be an educated consumer.”

Calmes says many addiction problems begin and end with responsible prescription use. Sticking to the regimen and the lowest possible dose necessary to treat the pain is one way anyone can hold themselves accountable. She also suggests having a trusted friend or relative help you manage your narcotic prescription if needed. Considering alternative treatment options like physical therapy or other activities before medication becomes necessary is another option. If medication is necessary, Harbor professionals often work with clients and their physicians to find alternative medications that have a reduced risk of being habit-forming.

“We try to help, support and communicate and make sure the client is a good consumer, but we’re also making sure we’re not introducing medicine that triggers a relapse and leads to dependency again,” says Butler.

If you or a loved one needs help with addiction and for a list of services, visit Harbor’s website.