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Recently, a panel of teens and experts in the fields of substance abuse treatment and law enforcement met with entertainment writers and members of the media to discuss heroin and prescription drug abuse by teens. The roundtable was sponsored by the White House Office of National Drug Control Policy’s National Youth Anti-Drug Media Campaign.
- Herbert Kleber, M.D., Professor of Psychiatry and Director of the Division of Substance Abuse, College of Physicians and Surgeons, Columbia University
- Derek Maltz, Associate Special Agent in Charge, New York Division of the DEA
- Roy Rutland, Detective, Narcotics Bureau, Miami-Dade (Fla.) Police Department
- Erica* and Josh,* teens who have experienced problems with heroin dependence
The following quotes are a sampling of excerpts from their conversation:
A brief overview of heroin . . .
Dr. Herbert Kleber: Heroin came into being over 100 years ago. It, like prescription painkillers such as morphine, is derived from opium and was originally marketed by the Bayer Company (makers of aspirin products) for medicinal purposes for use as a cough remedy.
Heroin used to be about 10-20 percent pure and was typically injected. Today, it’s 50 percent or higher. Due to the higher purity levels, it can more easily be smoked or sniffed. Over time, however, as tolerance to the drug builds, most addicts turn to injection.
Cause and Effect of Heroin Use . . .
Moderator: How did you first start using heroin?
Erica: I started snorting it then progressed to injecting. I was trying to get as high as I could as fast as I could. I could get higher faster by injecting.
Moderator: What led you to heroin?
Erica: I started drinking and smoking pot when I was 11 or 12. I moved to Ecstasy and eventually became addicted to cocaine.
Moderator: How did you pay for the drugs?
Erica: I was working at the time and would use the money from my part-time job to buy drugs. I emptied my bank account. I started to use heroin to bring me down from my cocaine high – so I could sleep, etc. Then started using heroin alone.
Moderator: Josh, what about you?
Josh: I started drinking and smoking pot when I was 13 and started snorting heroin when I was 16.
Josh: Boredom. There wasn’t a lot to do where I’m from. The kids I hung out with all used. That’s what they did for fun. Marijuana started getting boring so then I started doing pills and heroin.
When I first started snorting heroin, it would take two to three minutes to kick in. I would feel mellow. When I started shooting it, the effect was almost immediate.
Moderator: Erica, what was your experience?
Erica: There were a lot of reasons why I started. There wasn’t anything to do where I’m from either. My father’s death was part of it. My sister also used and I started using drugs with her. I wanted to be accepted. I stopped hanging out with my friends who didn’t use. Heroin was easy to get.
When I started using heroin, it gave me a kind of laid-back feeling. I just wanted to go to sleep. I just felt very comfortable.
Dr. Kleber: How long does that mellowness last? When you first inject, you get this intense rush that lasts for about 5 minutes. This is followed by several hours of mellowness, as if wrapped in a cocoon of good feelings. What goes on around you doesn’t seem to really bother you. Nausea and vomiting usually accompany heroin use but most addicts work through that.
There is about a one in four chance that those who try heroin will become addicted to it.
Where it comes from . . .
Moderator: How do you typically see people using heroin?
Detective Rutland: The majority of people I deal with start out snorting it but everyone pretty much winds up injecting it eventually.
Moderator: Where does this supply come from? How is it distributed?
Special Agent Maltz: Miami is an importation city while New York is a hub city. It comes into the New York area in kilos then is broken up and distributed to points northeast such as Boston, and west toward Chicago. One bag sells for about $10 in New York.
When the South American traffickers started selling heroin here in New York, they started selling heroin at the street level that was 80-90 percent pure to get the customer base. Now that they’ve got the customers, we are seeing the purity level drop some.
Moderator: Where did you get your supply?
Erica: Mostly in Brooklyn. It was about $8 a bag.
A friend of mine died of a heroin overdose. He got a bad bag [low purity] once, then the next time he went back [to that dealer] he got three times as much only the purity was much higher and he didn’t know it.
Moderator: Do you usually know how pure the heroin is that you’re buying on the street?
Erica and Josh: No.
Dr. Kleber: Every dose of heroin is like a game of Russian Roulette. One day you can get it at 90 percent pure, 30 the next. The Asians [traffickers] usually kept the purity level at about 15 percent. When the Colombians moved in, they grabbed the market share by selling 90 percent. Now that they’ve gotten the customers the levels are coming down.
As time goes on, users need to take increasing amounts just to keep from getting sick so they keep going back for more and more [withdrawal symptoms cause nausea, vomiting, severe sweating, goose bumps and more].
Moderator: How profitable is the heroin market?
Special Agent Maltz: One kilogram of heroin breaks down into about 20,000 bags, or hits. Each bag is about $10 in New York so that’s $200,000.
Detective Rutland: It’s easier to conceal when bringing it into the country than other substances such as cocaine. It generally comes into the country in bricks or via human mules [people who swallow heroin filled balloons or condoms and then enter the U.S.].
Addiction and help . . .
Moderator: What are some of the symptoms of heroin addiction?
Dr. Kleber: You [moderator] mentioned earlier that you have to have that morning cup of coffee in the morning to get you going. Without it you may not be as alert, you might get a headache as a result of missing that shot of caffeine. Now contrast that with heroin. You need a hit to get going. If you don’t get that fix, you know you are going to get sick, cold sweats, goose bumps, etc.
You don’t see too many cocaine addicts who have been at it for long periods of time like you do with heroin. Cocaine burns you out. It’s more of a short-term addiction compared to heroin where we see people who have used for 20 years or more.
Josh: I got to the point that I needed it just to get out of bed in the morning. I needed more and more to keep functioning and to keep from getting sick.
Moderator: Did your parents suspect something was up?
Josh: Not really, not at first. Nobody really knew anything was wrong, that I was getting high, until the end [of his addiction]. My dad started figuring it out but he was in denial. I’d be taking three and four showers a day because I was sweating so much [from withdrawals]. It was the only thing that would make me feel better.
I would do pretty much anything to get high. I would steal from my family and friends. My dad got me a Playstation for Christmas and a few days later I sold it. He got another one and a few days later I sold that one too. We were on about the third one when he started realizing something was up.
Moderator: How many people are addicted to heroin or other opoids?
Dr. Kleber: There are about 750,000 to one million heroin addicts in the U.S. The number addicted to prescription opiods [natural and synthetic painkillers such as morphine, OxyContin®, Percocet® and others] is approximately three times as high. Abuse of prescription drugs is the highest growing segment of abuse. While drug abuse by teens is declining overall, this segment is on the rise.
Moderator: How are teens getting and using these drugs?
Dr. Kleber: A variety of places. For instance, babysitting. Once the parents leave, the teen will check out the medicine cabinet. Other ways are from people who have obtained a prescription through a physician and turn around and sell it.
Detective Rutland: Parents are common unwitting sources.
A lot of the traditional narco-traffickers from the 80’s that were dealing in cocaine and other drugs are now pushing pills. OxyContin® can sell for $60 or more a tablet on the street.
Josh: I started by chewing Oxy but I also injected it. Chewing lasted longer.
Dr. Kleber: I’ve never met anyone who thought they’d become an addict. The younger you are when you start doing drugs, the more likely you are to spend more of your life on drugs.
Josh: Heroin is more affordable than marijuana. A gram of marijuana is usually around $25. That’ll give you a high for a couple, maybe three hours. A $10 hit of heroin lasts all day.
If you admit your problem now, there is a lot of help for you.
Moderator: What keeps you clean?
Erica: If I were to use today, I’d have a lot to lose. I’ve come so far, it’s not worth losing it. It can happen to you.
Moderator: What led to help?
Erica: On my last run, I was kicked out of my house. I had no place to go and I was sick. I knew I had hit rock bottom.
Josh: I wasn’t planning on quitting. I liked my life. I was in a short-term [treatment] facility that didn’t work. I went in thinking I wasn’t going to take it very seriously. I did a bag on the first day I got out. A week later I got locked up. After I got out, I did a bag on the next day. I got picked up again and after a week I wound up in Daytop [residential treatment facility]. I went there at first because I was probated there but then I began to like it. Now that I’m sober, I have a lot to look forward to other than the next hit.
*Names have been changed to protect the identity of the teen
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