Pubdate: Sat, 11 Jul 2015
Source: Standard-Examiner (UT)
Copyright: 2015 Ogden Publishing Corporation
Author: Jamie Lampros


OGDEN - Mark Kastleman got a call this week from a 65-year-old woman 
who started on pain pills for back surgery recovery and now, a year 
later, has turned to heroin to feed the opiate addiction she developed.

Unfortunately, her situation is not unusual.

"At our facility we've seen a big increase over the last year or so 
in the number of clients coming to us for heroin addiction," said 
Kastleman, partner and director of operations at Action Recovery 
Group in Ogden.

The use of heroin has increased dramatically over the past decade and 
overdose deaths have soared, according to a new report by the U.S. 
Centers for Disease Control.

Between 2002 and 2013, heroin deaths have nearly quadrupled in the 
United States. In Utah, from 2002 to 2013, the state has seen a 42 
percent increase in heroin deaths, said Anna Fondario, injury 
epidemiologist for the violence and injury prevention program at the 
Utah Department of Health.

In 2002, Utah had 64 heroin deaths. In 2013 there were 91 and 
preliminary data for 2014 shows 116 heroin-related deaths. That's a 
27 percent increase from 2013 and an 81 percent increase from 2002.

On average, 81 percent of the deaths were males and the age group 
with the highest number of deaths was 25 to 44 years old, Fondario said.

Across the United States, the CDC says the increase occurred among a 
broad range of demographics, including men and women, most age 
groups, and all income levels. Much of the increase is attributed to 
people who started using prescription painkillers before moving onto heroin.

Kastleman said there are several reasons people here are turning to 
heroin in such large numbers.

"Many people start out on prescription pain pills like Oxycontin for 
legitimate reasons - post-surgery pain, back injuries, etc. Over 
time, some become dependent on the painkillers, even after the 
original reason for the prescription has passed," he said. "Then, 
when the prescription runs out, or they can no longer afford it, they 
turn to the far cheaper and readily available alternative of heroin."

Most pain pills and heroin are derived from the same poppy plant, 
Kastleman said. They are very similar in chemical makeup and bind to 
the same opiate receptors in the brain. Prescription pain pills cost 
around $1 per milligram or about $60 for a 60 mg pill. Sixty mg. of 
heroin costs about $6, or one tenth the cost of prescription pain killers.

"Many teens report that it is easier for them to get heroin on the 
street than alcohol or even cigarettes," Kastleman said. Heroin 
addiction crosses all religious, ethnic, socio-economic and age 
boundaries, he said. Because it is so cheap and instantly available, 
anyone from anywhere can get it and afford it.

"We know of grade school children who get hooked, all the way up to 
senior citizens."

Kastleman said pain pill prescriptions are so common that many Utah 
families have them sitting in their medicine cabinets. Some teens 
will take their parents' or grandparents' pain pills and then sell 
them at school.

"This is how many kids are getting their first exposure to opiates. 
Then when the supply runs out or is too expensive, kids will turn to 
the far more available and cheap heroin alternative," he said. "A 
shocking statistic is that the U.S. consumes 80 percent of the 
world's pain pills with only 5 percent of the world's population."

The CDC reported that the use of heroin is affecting people in urban 
and rural areas, white, black and Hispanic, low, middle and high income.

Kastleman said people also turn to heroin because it has a powerful 
pain-numbing effect. It not only helps physical pain, but also 
emotional pain. Heroin also produces a very strong and enticing 
feeling of euphoria - a high that many addicts say is like nothing 
else they've ever experienced and once experienced is very difficult 
to stop seeking.

Symptoms of heroin use can include small pupils, sudden changes in 
behavior and disorientation, dry mouth and a cycle of hyper-alertness 
followed by a sudden nodding off.

"They will also often have a droopy appearance, like their 
extremities are heavy and lethargic. In addition, substantial 
increases in sleep time, slurred or garbled speech, wearing long 
sleeves or long pants to hid needle marks, even in warm weather," 
Kastleman said. "Some of the paraphernalia from heroin use can 
include things like needles or syringes, burned silver spoons, 
aluminum foil or gum wrappers with burn marks, missing shoelaces, 
used as a tie for injection sites on the body, straws with burn 
marks, small plastic bags with a white powdery residue."

Kastleman said his biggest advice to parents is to be aware and 
notice what is going on with their teens and young adults. Assuming 
that "my kid would never be involved with pain pills or heroin" could 
be a dangerous assumption. Talk openly and honestly with kids about 
addiction issues and don't be afraid to ask questions when you notice 
something that's not quite right, he said.

Also realize that pain pill and heroin addiction is not just a teen 
and young adult issue. Parents and grandparents must be very aware of 
their own use and abuse of prescription painkillers.

"It's far too easy to justify and rationalize the overuse of opiates 
until the individual wakes up one day to find themselves trapped in 
dependence and addiction," he said.

The Utah Legislature passed two laws in 2014 to help reduce drug 
overdose deaths.

Naloxone Law (House Bill 119) permits physicians to prescribe 
naloxone to third parties (someone who is usually a caregiver or a 
potential bystander to a person at risk for an overdose). It also 
permits individuals to administer naloxone without legal liability.

Good Samaritan Law (House Bill 11) enables bystanders to report an 
overdose without fear of criminal prosecution for illegal possession 
of a controlled substance or illicit drug.

"The Utah Department of Health developed pocket cards informing the 
public of how to prevent deaths from an overdose," Fondario said. "It 
includes information on how to recognize overdose warning signs, 
information on naloxone, how to administer naloxone, and who is at 
risk for an overdose."

Ten thousand pocket cards have been distributed in the last six 
months. To obtain one, got to:

All Intermountain community pharmacies stock and can fill 
prescriptions for naloxone and locations can be found here:

The Use Only as Directed website also has some information regarding 
drug overdose, who is at risk, where to get help, and information on 
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MAP posted-by: Jay Bergstrom