This is the third of a four-part series on heroin and opiate addiction in Iron County. It details the various health consequences that stem from this serious condition and includes a basic primer of the physiology of opiate addiction.
IRON RIVER—The beginning of the descent is often innocuous, as easy as swallowing a pill with a drink of water.
The journey itself is perilous, a long and winding road of devastating physical and emotional strife.
The end, if the journey is not aborted, is often calamitous.
Yes, the path to opiate or heroin addiction is like a latter-day version of Dante’s Inferno. But this journey is not an allegorical vision of the afterlife complete with a descent into hell, like the Italian writer Dante Alighieri produced in his epic poem “The Divine Comedy.”
This is real life for the addict. No symbolism needed.
“Sometimes I feel like I’d be better off dead,” said one local opiate addict.
That level of emotional despondency and the accompanying physical ailments are what lie ahead for the person addicted to opiates, a powerful category of drugs that are commonly used to treat pain.
If the sufferer doesn’t find a way to quit--usually accomplished through a variety of short-term and long-term treatment modalities--he or she dances with destruction.
First, consider the physical maladies associated with long-term opiate or heroin addiction. Even for the addict who doesn’t use needles to inject their opiate of choice, there is increased risk of respiratory problems, heart complications, liver damage and a weakened immune system.
For those who advance to needle usage, the problems multiply. As addicts often share needles, the likelihood of infectious diseases spikes.
“Anyone who gets to the point of IV drug use is at risk of many complications that come with needle use,” said Dr. John Lehtinen, who specializes in addiction medicine at Marquette General Hospital. “There are local infections and systemic infections like hepatitis C and HIV.
“Addicts will tell you that they never share (needles), but they do. And these (illnesses) are not a very good deterrent, either. They think, ‘It won’t happen to me.’”
But, of course, it does. Poor personal hygiene is often a consequence of IV drug use, and the addict’s insistence on a clean needle becomes less and less a priority, according to Lehtinen.
And when addicts share needles, they attract infectious diseases.
The use of needles goes hand-in-hand with heroin use. As the price of such prescription opiates like Oxycontin and morphine rise and drug manufacturers make the pill more difficult to crush in order to snort or shoot, more opiate addicts have sought out heroin.
“Heroin was a no-no in the past here,” said Lehtinen, who estimates that 90 percent of his multifaceted practice concerns substance abuse. “Now, it’s almost become fashionable. So the market for heroin has become flooded. It’s inexpensive and very accessible.”
As the addict progresses to stronger and stronger opiates, the consequences become more and more serious. At its most severe, addiction can lead to overdose and death.
The mental picture of actor Phillip Seymour Hoffman, who died of an overdose in February, is a stark reminder of what lies at the end of the journey.
Hoffman was reportedly found in the bathroom of his New York City apartment with a needle sticking out of his left arm and several empty heroin bags scattered around. He’d recently relapsed after more than 20 years of sobriety.
Hoffman’s relapse reportedly started with prescription painkillers but quickly advanced.
This type of tragedy is not just born of fame.
“You get to the point where you’re either going to stop or you’re going to die,” one Iron County addict said. “And you know that. You’re overdosing all the time. You do too much, and you lose consciousness.”
The question begs: Why does the addict risk all this potential damage and possibly even death just to use these drugs?
The answer to that question is complex, but a major piece of the solution resides in the addict’s brain. When an opiate travels through the bloodstream to the brain, the chemicals attach to specialized proteins on the surfaces of certain brain cells.
“The linkage of these chemicals with the receptors triggers the same biochemical brain processes that reward people with feelings of pleasure,” wrote brain researchers Thomas R. Kosten and Tony George in “The Neurobiology of Opioid Dependence.”
“Particularly in the early stages of abuse, the opioid’s stimulation of the brain’s reward system is a primary reason why some people take drugs repeatedly.”
If the individual continues to abuse the drug, brain chemistry changes result.
“Findings from brain imaging studies have identified profound disruptions in the specific brain circuits and cells that underlie addiction,” stated a 2010 National Institute of Health report on addiction.
As drug use continues, the brain adapts to the presence of the opiate and begins to function normally only when the drug is present.
If it’s not, the brain functions abnormally, producing the hallmarks of addiction – tolerance, craving and withdrawal.
Tolerance is simply the need to take higher and higher dosages of the drug to achieve the same effect.
Withdrawal symptoms include a host of adverse reactions including: anxiety, agitation, cramps, nausea, vomiting, chills, muscle pain and tremors.
Cravings for the drug can be psychological as well as physical, are often extremely intense and can crop up long after the addict is clean.
Once the brain has adapted to the opiate and, in effect, needs it to function, the addict’s life becomes a wreck.
“It gets to the point when you’re using just not to be sick,” an addict said. “It’s miserable.”
The final installment of this series deals with the recovery from heroin and opiate addiction.