Pubdate: Mon, 09 Feb 2015
Source: Buffalo News (NY)
Copyright: 2015 The Buffalo News
Contact: http://drugsense.org/url/GXIzebQL
Website: http://www.buffalonews.com/
Details: http://www.mapinc.org/media/61
Author: Teresa Wiltz, Stateline.Org

THE CHANGING FACE OF HEROIN ADDICTION

WASHINGTON - On Super Bowl Sunday, most football fans watched ads for 
Victoria's Secret, the lost Budweiser dog and a deadpan Kim 
Kardashian extolling the virtues of T-Mobile. But in St. Louis, those 
national ads were supplemented with a different kind of Super Bowl commercial.

On screen, the camera focused on the face of a white, middle-class 
teenager as he died of a heroin overdose. Off screen, a singer 
crooned along to perky guitar music: "First you stole prescription 
pills from your mom/You threw back a few and then they were gone/So 
you're jonesing real bad and you need some more. ... And that's how, 
how you got addicted to heroin."

Beginning in the 1920s, when heroin became illegal, people tended to 
think of heroin abuse as a problem plaguing people of color in the 
big cities. But in the past decade, heroin abuse has exploded - and 
it is hitting white people in suburbs and rural areas particularly 
hard. As the demographics of heroin use have changed, so have states' 
efforts to combat the problem.

"People have recognized that (heroin addiction) is a problem facing 
folks they know as well as groups that are distant from them. That 
certainly affects the way you view the problem," said Kurt Schmoke, 
who as Baltimore mayor from 1987 to 1999 was harshly criticized for 
his efforts to decriminalize drug use.

Twenty-seven states and the District of Columbia now have laws 
designed to make naloxone, a heroin antidote that is 99 percent 
effective, more easily accessible to overdose victims, according to 
the Network for Public Health Law. Since 2007, 21 states and the 
District adopted so-called "Good Samaritan laws" that provide some 
type of immunity for people calling 911 to report or seek help for an overdose.

Last year, Vermont Gov. Peter Shumlin, a Democrat, devoted his entire 
State of the State speech to his state's heroin crisis. Last month, 
Republican Gov. Larry Hogan of Maryland declared a "state of 
emergency" and pledged to dedicate resources to combat the heroin 
scourge in his state. And Democratic Virginia Gov. Terry McAuliffe 
has introduced six heroin-related bills.

"In some states, now that budgets are generally looking better, 
states are looking at this as a different problem than in the 
previous decade," said Karmen Hanson, program manager for the 
National Conference of State Legislatures (NCSL). "It's not just an 
urban problem; it's a rural problem. It's not just under the viaduct 
in the big cities. It's also a suburban problem. It's widespread 
culturally and ethnographically."

Between 2006 and 2013, the number of first-time heroin users nearly 
doubled, from 90,000 to 169,000, according to the U.S. Substance 
Abuse and Mental Health Services Administration (SAMHSA). Ninety 
percent of the people who tried the drug for the first time in the 
past decade are white, compared with an equal number of white and 
nonwhite users who got their start before the 1980s, according to a 
study published last year in JAMA Psychiatry.

"Heroin use has changed from an inner-city, minority-centered problem 
to one that has a more widespread geographical distribution, 
involving primarily white men and women in their late 20s living 
outside of large urban areas," researchers concluded.

Perhaps not coincidentally, the past two years have seen a remarkable 
uptick in "harm reduction" laws that focus on saving lives, rather 
than incarcerating users.

"With the changing demographics, there is the ability to frame this 
as a public health issue because many policymakers and law 
enforcement folks seem to relate to white users who are experiencing 
heroin use disorders more than people of color," said Kathie 
Kane-Willis, director of the Illinois Consortium on Drug Policy at 
Roosevelt University. Kane-Willis is a former heroin user who was 
introduced to the drug as a college student at Sarah Lawrence College 
in the late 1980s.

Ted Cicero, a psychiatry professor at Washington University Medical 
School and a co-author of the JAMA study, agreed that "when heroin 
became a white problem of middle-class kids," that got lawmakers' 
attention. "Now that it's hit home (for some legislators), it's 
become a major, major issue. No question the epidemic is growing. The 
demand is growing for it. And as long as there is that demand, the 
need will be met."

The shifting attitude fits a historical pattern, according to Marc 
Mauer, executive director of The Sentencing Project, a nonprofit that 
promotes sentencing reforms. In the 1930s, he said, the popular 
perception of marijuana was that it was "used in the racy part of 
town, in jazz clubs. The public perception was the users were 
Mexicans and African-Americans." As a result, Mauer said, marijuana 
was viewed as "the demon drug" and penalties for its use were harsh.

But by the 1960s, white, middle-class youth had started smoking pot 
and perceptions changed. Several decades later, Washington state and 
Colorado have legalized recreational marijuana use and other states 
are poised to follow suit.

The 21st-century heroin epidemic has its roots in the crackdown on 
the abuse of OxyContin, Vicodin and other opioid pain medications. 
According to the U.S. Department of Health and Human Services, nearly 
80 percent of heroin users say that they previously abused 
prescription opioids. When, for example, the formula for OxyContin 
was tweaked to make it more difficult to grind up to snort or inject, 
many abusers switched to heroin.
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MAP posted-by: Jay Bergstrom