Five myths about heroin

Five myths about heroin – 2016 – by Maia Szalavitz

But because drug policy has long been a political and cultural football, myths about opioid addiction abound. Here are some of the most dangerous — and how they do harm.

  1. Most heroin addiction starts with a legitimate pain prescription

People who misuse prescription pain relievers are 40 times more likely to become addicted to heroin than those who don’t, according to the Centers for Disease Control and Prevention

In the media, this fact is usually corrupted by failing to state that these are abusers of opioids, not patients taking their prescribed opioids: Only NON-Medical Opioid Use Leads to Heroin Use.  

That sounds like pain treatment is at the root of the problem, and the CDC is targeting doctors with new guidelines aimed at reining in prescriptions

But overwhelmingly, prescription-drug misusers are not pain patients. According to the National Survey on Drug Use and Health, more than 75 percent of recreational opioid users in 2013-14 got pills from sources other than doctors, mainly friends and relatives. Even among this group, moving on to heroin is quite rare: Only 4 percent do so within five years; just 0.2 percent of U.S. adults are current heroin users.

The proportion of patients who become newly addicted to opioid medications during pain treatment is also low.

A 2010 Cochrane review — considered the gold standard for basing medical practice on evidence — found an addiction rate of less than 1 percent. A study of more than 135,000 emergency-room visits for opioid overdose found that just 13 percent of patients had a chronic pain diagnosis.

Further, a 2015 study showed that only 6 percent of those who received an initial prescription for opioids took the drugs for more than four months; the authors didn’t determine how many of those ongoing prescriptions were medically appropriate and what proportion were linked to addiction.

The real risk factor for opioid addiction is youth. Like 90 percent of all addictions, the vast majority of prescription-drug problems start with experimentation in adolescence or early adulthood, typically after or alongside binge drinking, marijuana smoking and cocaine use. Having a prior or current addiction to another drug is the best predictor of developing problems with prescription drugs — not pain care.

  1. The best treatment for heroin addiction is inpatient rehab

When the media covers addiction among the rich and famous, they almost always include an inpatient stay at a plush rehab center. Dr. Drew Pinsky’s “Celebrity Rehab” is typical of such programs. Like many who run inpatient programs, Pinsky rejects the ongoing use of anti-addiction medication

Similarly, most drug courts and many state Medicaid programs also deny continuing access to the two best-studied maintenance medications, methadone and buprenorphine

The position that residential treatment centers and their abstinence-only philosophies are superior to medication ignores overwhelming data and keeps families from seeking the best care.

Let’s start with Dr. Drew’s patients: Nearly 13 percent who appeared on “Celebrity Rehab” died not long afterward; most had been addicted to opioids.

This is why the World Health Organization, the National Institute on Drug Abuse, the Institute of Medicine and the White House drug czar’s office all agree that maintenance treatment — indefinite, possibly lifelong medication use — is superior to abstinence rehab for opioid addiction

  1. Recovery from heroin addiction is rare

The prognosis for heroin addiction seems grim because of the high mortality rate and because rehabs typically report relapse rates of 60 percent or greater. However, the odds of recovery are better than they appear.

Early evidence for this idea came from studies of Vietnam veterans, who, as young men, should have had particularly high addiction and relapse risk.

Heroin and opium were cheap and easily available to American servicemen overseas; nearly half tried these drugs, and half of these soldiers became addicted.

But upon returning home, just 12 percent of those who had been addicted relapsed within three years, and only 2 percent were still addicted at the end of the study — nowhere near 60 percent. Fewer than half got any treatment, and it didn’t make a difference in terms of who recovered.

This phenomenon, known as “natural recovery” or “maturing out” of addiction, is common with other drugs, too. Large population surveys show that most people who are addicted to alcohol or cocaine quit without treatment.

So why do heroin addicts appear so hopeless in the public imagination? Because people who quit on their own don’t show up for treatment — and so, while they are included in large epidemiological studies, they aren’t included in treatment research. This means that rehabs see only the worst cases, leading to an unduly pessimistic picture of recovery.

  1. Tough love is the only thing that works

The idea that people with addiction must “hit bottom” — or experience the worst possible consequences — before they can get better is prevalent among parents and policymakers

But research shows that the opposite is true. Like any other human beings, people with addiction respond best to being treated with dignity and respect. Programs that nonjudgmentally distribute clean needles, provide overdose-reversal drugs or offer safe spaces for injection do not prolong addiction

  1. Whites have recently become the majority of people with heroin addiction

In an article headlined “In Heroin Crisis, White Families Seek Gentler War on Drugs,” the New York Times recently claimed that “today’s heroin crisis is different,” because it is not “based in poor, predominantly black urban areas” and because use “has skyrocketed among whites.”

What most of them omit is that the same study showed that whites have made up more than half of all heroin addicts since the early 1970s and hit 80 percent before 2000  


3 thoughts on “Five myths about heroin

  1. Stephanie N Marcus

    Stop the drug war with objective of shutting down the black market. The drug war has failed. The drug war is driving the problems, not fixing them. Decriminalization/legalization is necessary, it needs to be backed up with public health announcements explaining exactly why it is needed. Its not in any way condoning the abuse of addictors, it is done bc the alternative, the drug war, has made things infinitely worse on almost every level, to include making drugs abundantly available to any & all that wants them.
    We need to pull LE out of the drug biz – that will free up a lot of resources currently chasing their collective tails. When the laws create more harm and cause more damage than they prevent, its time to change the laws. The $1 TRILLION so-called war on drugs is a massive big government failure – on nearly every single level. Its way past time to put the cartels & black market drug dealers out of business. Mass incarceration has failed. We cant even keep drugs out of a contained & controlled environment like prison.
    We need the science of addiction causation to guide prevention, treatment, recovery & public policies. Otherwise, things will inexorably just continue to worsen & no progress will be made. Addiction causation research has continued to show that some people (suffering with addiction) have a “hypo-active endogenous opioid/reward system.” This is the (real) brain disease, making addiction a symptom, not a disease itself. One disease, one pathology. Policy must be made reflecting addiction(s) as a health issue.
    The war on drugs is an apotheosis of the largest & longest war failure in history. It actually exposes our children to more harm & risk and does not protect them whatsoever. In all actuality, the war on drugs is nothing more than an international projection of a domestic psychosis. It is not the “great child protection act,” its actually the complete opposite.
    The lesson is clear: Drug laws do not stop people from harming themselves, but they do cause addicts to commit crimes and harm others. We need a new approach that decriminalizes the disease. We must protect society from the collateral damage of addiction and stop waging war on ourselves. We need common sense harm reduction approaches desperately. MAT (medication assisted treatment) and HAT (heroin assisted treatment) must be available options. Of course, MJ should not be a sched drug at all.

    Liked by 1 person

    1. Zyp Czyk Post author

      I agree.

      Since prohibition, it has become a deeply ingrained falsehood that the drugs themselves are the problem. This has led to disastrous policies, for which our society has paid and is paying dearly.

      By refusing to address the real causes of addiction, all the money for the drug-war has been wasted on the wrong approaches. The current mess is just another sad result of the failed and failing drug-war.



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