Pubdate: Sat, 31 May 2014
Source: Vancouver Sun (CN BC)
Copyright: 2014 Postmedia Network Inc.
Contact:  http://www.canada.com/vancouversun/
Details: http://www.mapinc.org/media/477
Author: Denise Ryan
Page: A14

TEENS RIDING WAVE OF HEROIN USE

Popularity of opioids may be fuelling a resurgence the drug in Metro
Vancouver

Callum, a 19-year-old from Vancouver's west side, doesn't fit the
stereotype of a heroin addict, but his pathway to serious addiction is
a textbook case of a trend that is alarming experts: the trajectory
from prescription opiate abuse to heroin addiction.

In many ways, Callum fits a new profile; young, privileged and with
everything to live for, he fell into heroin addiction after developing
a dependence on prescription opiates.

His first narcotic high came after he found a bottle of Tylenol 3s, a
commonly prescribed painkiller, in his mother's bedside drawer.

"I ate about 10 of them, and went from feeling out of control to not
bothered," he recalls.

A so-called resurgence of heroin addiction has been dominating
headlines around the world. Some call it a "major comeback" and an
"epidemic." Others argue that heroin has never really gone away, but
its profile has been raised by the tragic overdoses of young
celebrities: Peaches Geldof, Philip Seymour Hoffman and last summer,
here in Vancouver, Glee star Corey Monteith.

The number of people across North America using prescription opioids -
including codeine, fentanyl, hydrocodone, morphine, hydromorphone,
meperidine and oxycodone - to treat severe and chronic pain has risen
dramatically during the last decade. The concurrent rise for
non-medical use has U.S. public health experts calling it "an emerging
public health concern globally," with "misuse increasingly common in
key populations including general adult and student
populations."

Health officials in Canada and the U.S. moved to counter that trend
with the introduction of abuse-resistant formulations that make
crushing, snorting and injecting prescription opiates more difficult.
But instead of solving the problem, health advocates say it is simply
pushing addicts toward heroin, a drug that is often easier, and
cheaper, to access.

In Vermont, for example, the crisis is so acute, governor Peter
Shumlin recently said: "What started as an OxyContin and prescription
drug addiction problem in Vermont has now grown into a full-blown
heroin crisis. We have seen an over 250-per-cent increase in people
receiving heroin treatment here in Vermont since 2000, with the
greatest percentage increase, nearly 40 per cent, in just the past
year."

Across Canada, officials are bracing for a similar trend: a rise in
heroin addiction directly tied to the rise in prescription opiate addiction.

In B.C., 61 per cent of overdose deaths between 2005 and 2010 were
accidental and related to the use of prescription drugs. At St. Paul's
Hospital, there has been an 89-per-cent increase in all
addiction-related emergency room visits in the last four years.

Vancouver, unlike Vermont, is not new to heroin. The problem reached
epidemic proportions here in the late '90s, when health officials were
counting an overdose a day, a crisis that prompted groundbreaking harm
reduction programs such as the supervised injection site, Insite. Now
officials, alarmed by the trend in other cities, anticipate a
resurgence here.

Opioids a drug of choice

Rates of prescription opioid addiction have soared across the
U.S.

Eighty per cent of the world's opioids are consumed in North America.
South of the border, among high school seniors, Hydrocodone is the
drug most commonly abused, second only to marijuana, and opiate
overdose is now the second-largest cause of unintentional death after
motor vehicle accidents, according to the Food and Drug
Administration.

Studies show similar patterns of use in Canada. In every city studied
across the country except Vancouver and Montreal, prescription opioid
use was more prevalent than heroin. From 2002 to 2005, according to a
study published in the Canadian Journal of Public Health, use of
prescription opiates among street drug users jumped 24 per cent.

In Ontario high schools, 20.6 per cent of students admitted using
prescription opioids, according to a 2010 study published in Canadian
Family Physician, up from 15 per cent in 2008. In that province,
prescription opioid-attributed deaths doubled between 1991 and 2004,
and rose another 30 per cent between 2005 and 2009.

Although data for Vancouver is less exact, the trend is ringing alarm
bells.

"In Canada, consumption of prescription opioids has tripled over the
past decade, and we are now the second-largest consumer in the world,"
said Dr. Thomas Kerr, co-director of the Urban Health Initiative at
the BC Centre for Excellence in HIV/AIDs.

"We are documenting a very large increase in prescription opiate use,
and we are interested in looking at how people initiate into heroin.
Heroin addiction can start with opiate addiction," he added.

"We need to understand what is happening here. Vancouver has such a
long-standing injection culture; if there is anywhere that it matters,
it's here."

One teen's story

It's a road that Callum has already travelled. The teen, who spoke
candidly and at length with The Sun, grew up in a stable west-side
home. He describes his parents as loving, successful, and financially
comfortable.

Like every kid, he said he "wanted to be accepted."

Around Grade 6, he said he began to experience what he now knows was
undiagnosed depression. Withdrawn, a reader and a dreamer, Callum
recalls Grade 8 as the first year he experienced real isolation and
difficulties. "I spent the first year of high school very alone. My
friends were all making new friends. Finally, the next year, I started
hanging out with old friends and one of them said, 'We should smoke
some pot this Halloween.'"

Callum didn't think twice about the pot smoking - it was simply a door
to having friends. "I was more interested in just having something to
do with them."

What he remembers most now is getting high. He felt the depression
lift. "It was the first time I felt like I could just smile for a
spontaneous reason. I loved that I could smile and laugh again and
have a release from my depression. It helped me feel OK with being
socially awkward."

Callum "almost instantly" became a regular pot smoker and more. "My
curiosity started getting the best of me. Within the first month of
trying pot, I tried mushrooms."

He bought whatever he could with his lunch money.

Eventually he admitted to his parents that he was using pot. "My
mother was very concerned. My father was unsure of whether to draw a
hard line in the sand or take the more accepting approach to see if he
could put himself in a position where I could share more things with
him. What inevitably happened was I remained dishonest with him and
took his ambivalence as a form of complacency."

Drugs of all kinds were readily available at his school, he said. By
Grade 10, he was experimenting with acid, ketamine, MDMA, cocaine,
DMT, Tylenol 3s, "all the drugs I knew that people I knew were doing
and that to a degree were accepted. I was very reckless. I was smoking
pot at lunch. Very quickly my reputation got out of hand."

His counsellor sat him down with his parents. By the end of Grade 10,
the school principal told him he was no longer welcome at the school.

He had also turned 16, and although he still lived at home he was
beyond his parents' control.

"I was exercising my independence," he said. "I decided I was going to
start selling drugs."

Callum enrolled in an alternative school. "The main reason was that I
had read (that) a lot of kids there were also drug users and would be
open to buying MDMA and K."

He figured it would be good for business.

At the same time, Callum was growing more fragile. "The drug use
amplified my depression; I was getting very emotional."

He began to steal from his parents, including that fateful bottle of
Tylenol 3s he found in his mom's drawer.

Callum had discovered opiates.

"Right after that I called my supplier and asked if she had any
painkillers."

Science behind the high

Heroin provides a cheaper, stronger high than prescription opiates,
but both work on the same receptors in the brain.

Risks and harms related to heroin abuse are well documented:
addiction, illnesses such as Hepatitus C and HIV, the risk of
overdose, and, because it's a street drug, a lack of control over the
quality of the supply.

"In Vancouver, rates of addiction remain persistently high, but deaths
have fallen," said Dr. Evan Wood, an addiction medicine specialist and
co-director of the Urban Health and Research Institute at St. Paul's
Hospital.

Since the opening of Insite, Vancouver's supervised injection site, in
2003, fatal overdose events decreased by 35 per cent in the
surrounding area, according to a study published in The Lancet.

The drop is largely due to harm-reduction initiatives and the widening
of availability of Naloxone, which can quickly and effectively reverse
an opiate overdose.

However, people do still die from heroin overdoses. It's often when,
like Corey Monteith, the user has also used alcohol, or has been clean
for some time and the body's tolerance to the drug is lowered, or the
drug is laced with a secondary drug such as Fentanyl.

Snorting and smoking

Opiate users of all ages and stripes are particularly vulnerable to
accidental "mixed-drug toxicity deaths" of the kind that killed Corey
Monteith, and which Vancouver coroner Barb McLintock says account for
the majority of deaths in B.C. that include opiates. Heroin and other
opiates are sedatives, slowing down the heart rate and breathing.
Alcohol has an "additive or synergistic" effect when used with
opiates, even in moderate amounts, suppressing respiration.

In spite of high-profile celebrity deaths - actor Heath Ledger had
oxycodone, hydrocodone and several other drugs in his system when he
died - opiates continue to be a problem drug.

"There is a resurgence of heroin as a problem drug, and a change in
who is using heroin to younger people and opioid users who are turning
to it for the first time," says Wood.

Although data in Canada is still sparse, Wood points to a recent U.S.
study that is drawing attention to the problem. "A recent study in the
New England Journal of Medicine looked at some of the restrictions
around OxyContin in particular resulting in people with untreated
opiate addiction turning to street heroin when diverted prescription
opioids become less available."

This worries Rob McGirr, a youth drug counsellor in Surrey and former
police officer. McGirr has seen the evolution of the problem firsthand.

"There's been a transition and kids seem to be shifting to more
sedative drugs," he said, nothing that he first started to see teens
using OxyContin seven or eight years ago. "It's been a huge problem in
the U.S. and sooner or later we knew we would see it here. OxyContin
is quite expensive on the street, about $35 a cap. Heroin is about
half the price."

McGirr said the pricing for OxyContin "can be very erratic," depending
on its dosage and other factors.

Heroin is usually packaged in "decks" or "flaps," he added. "The usual
lowest amount packaged is a 'point' of heroin (1/10th of a gram
[100mg]) and is usually $15. This would be considered a single dose."

Younger kids are experimenting with snorting and smoking heroin, or
"chasing the dragon," which involves inhaling the vapour released
after heating the drug on a piece of foil.

It's not just that heroin is a cheaper narcotic high. McGirr cites
another reason. Kids are not seeing the ravages of the drug: "In 1999,
2000, heroin had a bad name. Everyone knew a kid that had experimented
and they saw what happened. That group of kids is 27, 28 years old
now, dead or in jail. The drug has been off the radar for teen use for
so long, it's enjoying the status of (being) the new drug."

The problem is that patterns of addiction with opiates, prescription
or street heroin develop so quickly, users "don't have time to change
their minds."

A slippery slide

The first prescription opiate Callum's dealer gave him was morphine, a
big step up from Tylenol 3s. For Callum, morphine was magic. "Going to
bed in a good mood, waking up in a good mood, just feeling warm and
like no obstacles will overcome you, like there is no reason to be
worried or concerned."

Although prescription opiates are designed to treat severe or chronic 
physical pain, the narcotic took care of something else for Callum: "My 
emotional pain."

By Grade 10, Callum was still living at home, using morphine as often
as he could and dealing at the small alternative school where he says
he was "technically enrolled."

"It simply got worse at that point. As soon as my old friends that I
had done drugs with saw that I was getting into morphine and opiates,
they got scared and started distancing themselves," he said.

One night, he was on his way home from doing his regular "runs" (drug
deliveries) with $20 in his pocket. He had hoped to use the money to
pick up a cap of one of his regular prescription opiates, but had no
luck. He ran into someone on the bus who offered him heroin instead.

"I thought to myself, It's f--king heroin, this is not a good idea. At
the same time, I thought, but it is an opiate. This is your last chance."

At first he said he didn't see it as much different than the
prescription opiates. He moved from snorting heroin to smoking it.
"But from that moment, heroin started dominating."

Soon, he said, he started to prefer it. He was addicted. From that
point forward, the 16-year-old began using daily. Conflicts grew and
he left his parent's house, to stay with his dealer. Lulled by the
drug into a kind of apathy, he could see the future but had no power
to resist.

"In my head I was imagining myself living on the Downtown Eastside,"
he said. "Instead of that thought or image compelling me to run back
to my parents and try to clean up, it felt more like I was just
mentally preparing for the inevitable."

But Callum was arrested in a police sting after his school liaison
officer was informed he was selling drugs at school. His dad came to
pick him up at the police station.

"I cried the whole way home," he confessed. "My parents thought, 'This
is it. This is the intervention he needs to get his life on track.'"

Instead, he started bingeing. Callum wasn't going to go into rehab
willingly. He moved back in with his dealer. Two months later, he
missed his court date. After turning himself in the next day, Callum
was released to his parents under the conditions that he had to attend
a rehab of their choosing.

After a seven-day detox, Callum's parents took drastic action. Because
Callum was 16, his parents had no way of forcing him to stay in rehab
in B.C. If they got him into the United States, however, he would be
under his parents' control again, due to more restrictive laws.
Without telling him where he was going, Callum was taken to the
airport, loaded onto a chartered private jet and flown to Utah. "It
felt to me at the time that I was being kidnapped."

In Utah, Callum was strip-searched, given a backpack with necessities,
blindfolded and driven to a camp in the wilderness. He spent 11 weeks
in the program and then moved to a residential treatment centre north
of Salt Lake City for 11 months, where he was able to finish high school.

He's been sober ever since.

Now a student at a university in another province, majoring in
psychology, he finds visits to Vancouver challenging.

"Just being in Vancouver puts me on edge," he said. "My Dad would be
driving me down Broadway, and I'd see the Tim Hortons and think about
when I did drugs there. A corner where I bought drugs, another corner
where I stole drugs. No block was safe."

He goes to meetings, talks to his parents often about how he is
feeling emotionally, and tries to address situations and feelings "as
they come up."

To kids who are experimenting with drugs and might be feeling low
after a weekend of partying, Callum says he hopes they will understand
their "low feeling could be related to their substance use, and that
it won't go away with more and more powerful substances, but only get
worse."

The cognitive therapy he received in rehab has provided Callum with
new coping tools. "Coming back from a run one day, I just lay on my
bed and felt like I was on ecstasy. I realized that by doing all those
drugs I was robbing myself of that ability to feel that sensation 
naturally."

Now he is working to reclaim his life, one small pleasure at a
time.

Early intervention

Dr. Evan Wood, who is spearheading an addiction medication training
program at University of B.C., believes that in addition to ongoing
efforts to reduce the prescription and availability of opioids, health
care providers must move toward early intervention. "The question I am
asking is, how do you catch people before they become addicted?"

The issues are complicated: the very real needs of patients who
require pain treatments must be weighed against very real issue of
narcotic addiction and dependence, and the problems caused when
prescription drugs are diverted to the street.

When it comes to anyone who might be addicted to opioids, whether it
started with a prescription for pain relief, or a pill bought on the
street, Wood believes the answer is going to take a concerted and
multi-pronged approach: continued efforts at harm reduction and
educating physicians so they can recognize and treat the problem.

"Just speaking to someone in a white coat who knows about addiction
and can lay out the statistics in terms of a bad outcome, and say,
'These are the things you can do to alter the trajectory you're on,'
that's impactful," he said. "But most primary care physicians aren't
necessarily equipped with the tools to help with addiction. It's a
fundamental barrier."

Wood believes that highly publicized celebrity deaths, such as Corey
Monteith's, are too often a lost opportunity for education. "We need
to seize these opportunities as public education opportunities to
discuss why deaths like this happen and why we need to address the
very real risks and dangers associated with opiate abuse."

* Callum's name has been changed to protect his identity.

[sidebar]

Addiction

TODAY: May 31 - RESURGENCE AMONG TEENS Growth of prescription opioid u
se linked to heroin addiction.

MONDAY: June 2 - SAVING LIVES Naloxone is saving lives by reversing an
opioid overdose. But it is not readily accessible.

TUESDAY: June 3 - SAFE INJECTION SITES Heroin use is on the rise, but
some fear harm reduction efforts aren't meeting demand.
- ---
MAP posted-by: Matt