Overdose, drugs, and death. When an overdose happens, at a certain level part of you may not have been surprised. After all, there has been a pattern of use for years, and while you kept some hope, the writing was on the wall for a while: not if, but when would your loved one or yourself overdose.
Your loved one may be recovering from an overdose or perhaps did not survive. You are not alone in this experience. Even if a specific drug is on the rise nationally, but there are fewer users locally, those that are using heroin are more at risk of overdosing than ever. Why is this?
Texas Decline In Heroin Use, Rise In Overdose
In 2016, 948,000 Americans reported using heroin in the National Survey on Drug Use and Health (NSDUH). While that number has been increasing nationally, Texas is experiencing a decline in the number of adults who reported heroin use in the 2018 survey. There were 14,966 deaths nationally from heroin overdose in 2018, a 4.1% decrease from one year earlier, according to the National Institute on Drug Abuse.
But for every death, there are many more non-fatal overdoses. There was a 3.6% increase in nonfatal emergency room visits from heroin overdose from 2016-2017. And some people never go to the emergency room for fear of legal repercussions. There is no way to capture data on this group.
What is known about those who experienced non-fatal heroin overdoses and were treated at emergency departments? A 2018 article published in the American Journal of Preventive Medicine analyzed emergency room visits from 2010 to 2014 and noted these facts:
- Two-thirds were male versus female
- People ages 25-34 made up 42% of heroin overdose visits
- The Midwest, South, and West saw nearly double-digit percentage increases in visits in the past year, and the Northeast dropped 8.8%
These might show numbers from a national perspective and are helpful, but let’s delve a little deeper into Texas-specific heroin facts. Heroin overdose deaths in Texas have risen steadily since 1999, briefly declining only once in 2010, reaching 668 in 2018. If you or someone you know is suffering, we offer treatment for heroin use disorder.
While this highly addictive, illegal substance can be harmful to someone’s health, there has been a second force at play behind the upward trend of heroin overdose.
Fentanyl, a synthetic opioid for pain management, has increasingly been added—or cut— into heroin because it costs less to produce and is smaller and therefore easier to smuggle. This is done at the distributor level to maximize a supply; dealers and users are generally unaware of the increased potency and potential for overdose.
They have an established protocol of a quantity they are used to taking and an expected reaction time and length. However, the effects of heroin can already cause a life-threatening situation due to side effects. Adding fentanyl and its complications further compounds the risks, making it much more potent, and potentially deadly.
Heroin Overdose Symptoms
Symptoms of someone who is overdosing may include
- Slow, shallow breathing
- Pinpoint pupils
- Loss of consciousness
- Respiratory failure
- Blue skin from lack of circulation
Emergency Rooms To Better Track Overdose Causes, Evaluate Mental Health
Because the emergency department statistics haven’t been tracking consistent consideration of polysubstance use (multiple drugs), what is considered a heroin overdose may be a fentanyl overdose—and vice versa.
The increase in emergency room visits for heroin overdose, whether fatal or not, point to opportunities for change in the following areas, as pointed out by the Centers for Disease Control and Prevention (CDC):
- In September 2019, it created the Overdose Data to Action program (OD2A) to increase monitoring of data in a more timely and local manner and provide data-driven prevention activities.
- Enhancing treatment follow-up services at the emergency-room level is another goal. This could include:
- Providing naloxone for reversal of a future overdose
- Screening for dual diagnosis for a mental health condition
- Evaluating prescription histories and monitoring opioid prescriptions to ensure following CDC guidelines to prevent addiction and overdose
“With these activities, many persons who would have died from a fatal overdose are now able to receive life-saving care, including better access to medication-assisted treatment, which might be initiated in ED settings.” according to an April 2020 CDC weekly report.
Heroin needle use can increase the risk not only for overdose but also for HIV and hepatitis C virus (HCV). In 2017, 3.2% of men and 13.3% of women who were newly diagnosed HIV-positive, traced origin back to sharing of needles for drug use. Thirty-five people were diagnosed as HCV positive with 205,500 people living with the virus, again specifically traced back to shared needles with an infected person.
What Is Heroin?
Heroin, also known as diacetylmorphine, is processed from morphine which is created naturally from poppy plants. U.S. heroin is typically sourced from Columbia and Mexico, just over the Lone Star State’s border.
It has a short window of active time requiring more frequent use to get the desired effect. Typically, over time the body develops a tolerance to side effects from drug use. However, tolerance for respiratory depression is slow to adjust and can lead to overdose.
The white power pure heroin is more common east of the Mississippi River, has a bitter taste, and is typically snorted or smoked. Interestingly, stigma regarding drug use exists between the population who do not take substances and those who do. Within that latter group is another level of stigma in which new users might look down upon someone who injects heroin. As addiction grows, the lines blur between acceptability.
Black tar versions of heroin resemble just that and are sticky and more common in the section west of the Mississippi, like Texas. Unlike pure heroin, it is more crudely processed and impurities remain.
Heroin Overdose Can Cause Overload Of Emotions
We spoke earlier about finding out someone you love, or perhaps yourself, have overdosed on heroin. While you may be feeling shocked, you may be experiencing a range of emotions you were NOT expecting.
- Confusion because you had just seen them the day before, and they kind of seemed okay. Based on appearances, you sure didn’t think this would be the day.
- Shouldn’t it have seemed more dramatic? Learning about your sister’s death at 2:30 p.m. on a Tuesday at work is a lot different from the 1 a.m. phone call you were expecting someday.
- Guilt because from time to time, you had both used heroin together, but here you still stand while they are in a coma in the hospital.
Stigma Of Heroin Opioid Overdose
A 2020 article in Addiction Research & Theory analyzed interviews from Norwegian parents regarding the drug-related death of their loved one and found four main themes that emerged:
- The burden of constantly being in a state of being prepared to learn about their loved one’s death
- Public perception of addiction and personal feelings about a loved one’s substance use
- Emotions surrounding the overdose event of guilt, shame, relief, sadness, despair
- Necessary tasks regarding public and personal notifications
The burden of stigma exists. People have had an image of someone who doesn’t care about others, lacks any interest in contributing to society, is physically repellent, and has poor hygiene. This comes from the long-held practice of dismissing someone based on their addiction, family embarrassment, by the community for being considered of weak character, and just not quite seeing the individual person who has a substance use disorder.
These generic attributes belie the truth behind substance use.
Heroin’s recent rise has an interesting background on the medical side. Did you know that Purdue Pharma, the maker of the prescription opioid OxyContin®, pleaded guilty to three criminal charges in November 2020? It acknowledged nefarious activities such as falsely portraying the establishment of a program to keep the prescription-level product off the black market (no such one existed), targeting and encouraging prescriptions, and paying doctors to encourage others to write prescriptions.
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Once prescription opioid crack-downs came, patients were already addicted. In many cases this is a direct result of overprescribing by doctors, some for reasons listed above. Patients had no supply and in desperation moved on to heroin. Heroin is a Schedule I drug, and it is not legal to prescribe heroin in any capacity in the United States. These were people who were originally seeking pain medication for a specific ailment, and they became hooked when they weren’t even originally seeking drugs to achieve a high.
This changed the stereotypical face of addiction as people saw this addiction more and more with a loved one. A stranger was no longer behind the face of addiction—it was their wife, son, or even themselves who were addicted.
Heroin Detox/Rehab Treats Opioid Dependency
At Vertava Health Texas, we offer compassionate, evidence-based care to individuals who are often judged and dismissed by a community. Our medically-supervised detox treatment was designed to make detox as comfortable as possible for you or your loved one. Once detox has been safely managed, we have treatment programs including inpatient, outpatient, and online, all providing clinically-proven therapy techniques with excellence in care by our clinical team. We believe in a planned approach to relapse prevention through patient resilience. Vertava Health Texas knows recovery is tough, and so are you. Call us at 877-318-2084.
How Much Heroin Leads To Overdose?
Overdose is common as a consumer rarely knows how much they are taking per purchased dose. Contaminants in heroin can range from flour to fentanyl, so getting an accurate dose is difficult when dealing with street drugs. This unpredictability leads to inaccurate dosing levels and overdose.
Method of use is also a factor with overdose. For instance, injecting heroin that is mixed with a coagulant substance such as talc can cause vein collapse.
What Happens When You Overdose On Heroin?
When you overdose on heroin, the depressant factors of the drug are taking effect, breathing becomes slower as the lungs shut down, heart rate drops, and loss of consciousness sets in. As blood stops circulating, a bluish tinge will appear on the skin, fingernails, eyelids, and lips. 9-1-1 should be contacted immediately.
How Do You Treat Heroin Overdose?
You should call emergency services immediately, check for breathing, and make sure breathing passages are clear. Administer naloxone if you have it, either through a nasal spray or needle injection. It may need to be repeated several times. Even if a person is revived on the scene, emergency services should be seen and follow-up treatment obtained.