“Beating heroin is child's play compared to beating your childhood.”
― Stephen King, The Waste Lands
"Selfportrait under the influence of morphium" Ernst Ludwig Kirchner (1880-1938)
The untimely and unfortunate death of Phillip Seymour Hoffman has precipitated an intense reaction. We've seen our share of celebrity deaths and drug addictions over the years but this one seems to have left a mark on people. Judging by reactions in the media and online, Hoffman didn't fit the stereotypes people hold about who is and isn't likely to be a junkie. As one friend told me on why she was so affected by the news, "He was such a vulnerable character. You got the sense he was tapping into his own insecurities to give life to his roles. He just seemed like such a good person and was the last one I would have expected to hear had overdosed on heroin."
Perhaps more than any other drug of abuse, heroin is shrouded in misinformation and misunderstanding. It is pervasive and when it comes to the internet and social media the errors are compounding. Over and over, as I read stories and their comments about Hoffman's sad final exit, misconceptions about heroin, opiates and the nature of addiction dominated the conversation. It is with an eye toward clarifying the issue and promoting understanding that I offer you my Top 5 Misconceptions About Heroin and Addiction.
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A little context before we get started.
Beginning in my middle school years, after we had left the farm and were living in Houston, I was growing up as part of the arts community. My rogue brother commonmass, being three years older, attended the local arts magnet high school and much of my young life from thereafter was influenced by this culture. Modeled after the famous Fiorello H. LaGuardia High School of Music & Art and Performing Arts the atmosphere was of intense dedication and preparation for a serious professional career in Music, Art, Vocal, Theater and Dance. This frenetic, competitive environment drew kids with real talent from all walk of life. Based on rigerous audition and without regard for financial status or academic test scores, admission was for the best of the best and meant an eclectic group of misfits. We always said it was a school for freaks, and we saw that as a point of pride. With all of that talent and freak, though, came plenty of baggage. Part of that baggage was drugs.
I saw my first heroin overdose in 11th grade. The kid lived with another student and rented from a notorious chicken hawk who pimped runaways from the Westheimer strip. He survived.
Then in college we used to take bets on who, when and from which studio would come the next overdose. There was one almost every semester like clockwork, sometimes two. I used to hang around these people, they were my friends. Some of them I collaborated with. A few of them have big careers in New York and London now. More of them are dead.
Since that time I have lost 3 friends to heroin overdose, one intentionally by suicide. I don't have enough fingers to count the folks I know who have had serious habits over the past 20 years and I can count one hand the ones who have been clean for more than five. Drugs in the arts community are ubiquitous, and heroin in particular for the Visual Arts. Chalk it up to the same reasons my high school was full of freaks with baggage if you will, I think that is certainly part of it. Regardless of the why, it's a reality. In the art world you find heroin, even if you aren't looking for it.
Now in my forties, I am a big proponent of Harm Reduction. I believe that users should be educated about things like safe methods of injection, not heating their gear when shooting up and how to properly deal with an abscess. These things are important becasue heroin is illegal and the penalties for being caught with drugs or paraphernalia in almost all areas are swift and severe. I don't advocate legalizing heroin but I do advocate decriminalizing addiction.
So it follows that I also believe the public needs an overhaul in understanding heroin addiction in particular and drugs/addiction in general. We can't have a serious discussion about addiction when one party thinks it is a moral failure and we can't affect positive change in addiction healthcare if needle exchanges are illegal.
bastrop's Top 5 Misconceptions About
Heroin and Addiction
No. 1: Addiction is a choice. They could stop if they wanted to they are just too weak.
Forget that every junkie will tell you if they could do it all over again they never would have started. Heroin (and many other drugs) change your brain chemistry. Though the psychological addiction to heroin is tremendously powerful, physical addiction is not something that you can just put down.
How Does Heroin Affect the Brain?
When it enters the brain, heroin is converted back into morphine, which binds to molecules on cells known as opioid receptors. These receptors are located in many areas of the brain (and in the body), especially those involved in the perception of pain and in reward. Opioid receptors are also located in the brain stem, which controls automatic processes critical for life, such as blood pressure, arousal, and respiration. Heroin overdoses frequently involve a suppression of breathing, which can be fatal.
After an intravenous injection of heroin, users report feeling a surge of euphoria (“rush”) accompanied by dry mouth, a warm flushing of the skin, heaviness of the extremities, and clouded mental functioning. Following this initial euphoria, the user goes “on the nod,” an alternately wakeful and drowsy state. Users who do not inject the drug may not experience the initial rush, but other effects are the same.
Regular heroin use changes the functioning of the brain. One result is tolerance, in which more of the drug is needed to achieve the same intensity of effect. Another result is dependence, character-ized by the need to continue use of the drug to avoid withdrawal symptoms.
No.2: Heroin addicts are bad people who live on the street and turn to crime to support their habits.
Exibit A: Phillip Seymour Hoffman. Not all heroin addicts are poor street urchin criminals. In fact, many heroin addicts begin with prescription opiates from their doctor and start their opiate careers on middle class suburbs.
Beyond that, while it is true that some junkies end up on the street and that heroin can fuel property crime, it's driven by the physical addiction. When your body is withdrawing you feel so terrible that you will do anything in your power to not feel that way. Most heroin abusers at that point are maintenance users, meaning they are using simply to feel normal. Long gone are the tremendous rushes and the incredible highs. Users at that level are using largely to feel "well".
The way to remove the crime incentive and to assist in addicts regaining control of their lives is for the state to invest in addiction healthcare. Specifically, governmental bodies should move away from Methadone programs and into a less destructive and more manageable replacement therapy with Suboxone. This is a whole other diary in itself, but if you are interested start at this link and go from there.
Which brings us to...
No.3: That junky's heroin habit is different than when I tell my doctor the pain lingers and I need him to refill my hydrocodone prescription.
Heroin is an opiate derived from the Opium poppy (Papaver somniferous). The same goes for codeine, hydrocodone, oxycodone and a host of other psychoactive compounds used to treat pain and other ailments. The biggest differences between a heroin habit and the habit many "normal" people pretend they don't have is how the drug is administered, how long the drug lasts in the body and how much of the drug is consumed. Anyone who has taken prescription pain medication for more than a couple of weeks has experienced withdrawal when they stop. That withdrawal is exactly the same withdrawal a heroin addict experiences, the difference is only a matter of degrees, and the distance between those degrees can be narrowed quickly. This myth is a self delusion people maintain to justify their behavior. Opiate addiction is opiate addiction regardless of race, social status or where you obtain the drugs.
No. 4: Addicts have to hit rock bottom before they can be treated.
This is one that really pisses me off. While it may be true for some addicts that they personally needed to hit that bottom before they had a moment of clarity and sought help, this is a dangerous fallacy for the public. It is never too early to help someone get help and it is never too early for an addict to get clean. They may not want to get clean, but there is certainly no physiological reason for it, only psychological. The psychological reasons can be overcome if an addict knows there is treatment available, which is obviously the biggest problem of all. There is not enough addiction healthcare available for all of the people who need it and want it. If we were really aging a War on Drugs, fighting it like we fought the Nazi's in WWII, we would stop locking people up and put those resources toward effective treatment. Instead we fight the War on Drugs that Ron and Nancy gave us and we wage it like W did on Iraq. It's criminal, it's immoral and it is ineffective.
No. 5: It can't happen to me.
LOL to this one. That is what every single heroin addict told themselves from the outset. See exhibit A at the top of the chart.
Moreover, heroin addiction typically begins these days with a script from your doctor. Most addictions aren't single substance addictions but are polydrug addictions, where the abuser is using several drugs in combination and is concurrently addicted. We've already established that your doctor is just as likely to spark your habit with pain killers, but that Xanax you got for you anxiety and the muscle relaxer he gave you with the Vicodin when you hurt your back can work together to create both he pleasurable sensations that keep you coming back for more as well as gang up to keep your habit growing. When it comes to heroin, most overdose deaths are polydrug deaths. It's the alcohol or xanax that tipped them over the line and depressed their breathing to the point of arrest. This is also the case with prescription opiate overdose deaths.
My hope is we will learn to treat addiction as the disease that it is and stop the punitive nonsense policies that up until now have created this problem for society. For this I hold out hope but that hope is tempered by reality. We are not in that place and I don't think we are even close. We can do our part, as informed and progressive people, to move the conversation in that direction whenever we encounter the ignorance that keeps us in the dark ages. Fight ignorance with knowledge. Above all, be compassionate. We are all human and we all deserve to be treated with respect.
“The question is frequently asked: Why does a man become a drug addict?
The answer is that he usually does not intend to become an addict. You don’t wake up one morning and decide to be a drug addict. It takes at least three months’ shooting twice a day to get any habit at all. And you don’t really know what junk sickness is until you have had several habits. It took me almost six months to get my first habit, and then the withdrawal symptoms were mild. I think it no exaggeration to say it takes about a year and several hundred injections to make an addict.
The questions, of course, could be asked: Why did you ever try narcotics? Why did you continue using it long enough to become an addict? You become a narcotics addict because you do not have strong motivations in the other direction. Junk wins by default. I tried it as a matter of curiosity. I drifted along taking shots when I could score. I ended up hooked. Most addicts I have talked to report a similar experience. They did not start using drugs for any reason they can remember. They just drifted along until they got hooked. If you have never been addicted, you can have no clear idea what it means to need junk with the addict’s special need. You don’t decide to be an addict. One morning you wake up sick and you’re an addict. (Junky, Prologue, p. xxxviii)”
― William S. Burroughs, Junky
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