By Karen James, LCSW-C
Why do community groups, news sources, city and state task forces and the White House say we are in the midst of an epidemic? What exactly is a heroin epidemic? To understand this, we need to put aside what we knew, or thought we knew, about both epidemics and drug addiction. Any knowledge or opinion from before 2005 is too outdated to be helpful or accurate.
“Epidemics” are not necessarily about infectious or contagious diseases; the term can describe a rate of incidence that has increased very significantly. Drug addiction is also different than most of us remember. Images of inner city squatters, “heroin chic” models, street people and famous musicians are now heroin history. Today it can be the person next door. Any American face can now be the symbol for this epidemic. All classes, genders, ages, socio-economic statuses are over-represented among heroin users.
What’s the reason for the change? Heroin is easy to get. No need for the drama of dark alleys and corner drug pick-ups. Most first-time and early users of the drug get the heroin from friends in social situations. Users with financial resources can get deliveries to their door with one easy phone call. But you don’t have to be rich to be a heroin addict. For those of less comfortable means, the drug is not only affordable — heroin is cheap. On the street, it may cost $80 for one pill of a prescription painkiller like Percocet, while $10 worth of heroin can create the same ‘high”.
How does heroin use in Baltimore fit this “epidemic” model? Researchers look at baseline rates of incidence and track those rates. If some issue increases well beyond what is expected, it can be described as an epidemic. In the first quarter of 2014, there were 70 heroin overdose deaths reported in Baltimore. Over that same time period in 2015, there have been 140 deaths—that’s a 100% increase and well beyond what was expected. According to the U.S. Drug Enforcement Agency, Baltimore has the highest per capita heroin addiction rate in the country , and the federal government has designated our city as a High Intensity Drug Trafficking Area. Sadly, Baltimore is not alone. In Maryland, heroin related overdose deaths have more than doubled since 2010.
These statistics, albeit alarming, aren’t the only factors at play here in creating an epidemic. Heroin’s virulence or potential for harm is strengthened by its easy availability and relatively inexpensive cost.
In addition, the heroin of today is much stronger than that used in the past. It is a pure product now. It is cleaner and more powerful. Its new potency opens up new avenues for heroin use, so now injection is no longer the only means for using the drug. Heroin is clean enough to smoke or snort. People who would not inject a drug may now become addicted to heroin through these other methods. They fool themselves into believing that the purity of this drug makes it safer. Yet that purity actually makes it more lethal.
Scientists also describe susceptibility as a factor in an epidemic. This often refers to a problem moving at a high rate to a different population group. In 2000, the average user was a black person aged 45-64. Now the average user is a white person aged 18-44. The rates of use and rates of overdose death have skyrocketed in Baltimore. Some estimate that Baltimore City has 60,000 heroin addicts. That would be 1 of every 10 residents. This is far ahead of national statistics, and it’s why some people refer to Baltimore as the Heroin Capital of the U.S.
What has made more people vulnerable? For heroin, the vulnerability or susceptibility was created by easy access to prescription pain pills. It has been reported that 1 in 20 patients have used their pain medication for non-medical use. If someone develops a tolerance to their own medication, they may get some from family members or begin to pilfer medicine cabinets when they visit. If access or the higher costs of pills limit availability, they will often turn to heroin. They are just moving from one form of an opiate to another. 45% of heroin users began with addiction to pills.
Heroin use has infiltrated every demographic in our society. Heroin has become both an easy access drug and an equal opportunity killer. What can we do for our Baltimore community?
1) Educate ourselves. Let go of the false comfort inherent in certain beliefs about what “type of person” is or is not affected. Dispel those myths. No one is safe.
2) Get involved. Support community efforts for education, prevention and treatment.
3) Push for quality care and full access to treatment. When someone is turned away from treatment due to lack of resources, it is never known if they will still be alive when an opening becomes available.
4) Remove the stigma by helping to educate others about these realities. Stop making social judgments about a person’s worth based on particular behaviors.
5) Take responsibility for our own medications. Question ourselves: are we using our medications appropriately? Empty our medicine cabinets of any unused pain pills.
Our city, our state and our world have changed. No community is immune to the forces of this epidemic. The Jewish community cannot rest on old understandings of addiction and who may be susceptible. Heroin does not respect demographics. Heroin is here. It ruins lives. It often kills.
Here are three upcoming community events focusing on the heroin epidemic:
The Heroin Epidemic: In Our Backyard
Hosted by the Metropolitan Issues Commission of the Baltimore Jewish Council & the Governor’s Office of Community Initiatives. Wednesday, September 30th, 2015 5:30pm. More information at baltjc.org.
UNITE To Face Addiction Rally
Jewish Community Services is proud to join over 450 local, state and national organizations at the “UNITE to Face Addiction” rally, a free event on the National Mall in Washington, D.C. on Sunday, October 4, 2015. More information at jcsbaltimore.org.
Right in Our Backyard: The Drug Addiction Epidemic in Suburbia
Temple Oheb Shalom and Jewish Community Services are presenting a program on the crisis of opiate and heroin addiction among our teens and young adults. Sunday, November 8 at 3pm. Contact Caitlin@templeohebshalom.org or call Howard Reznick at JCS, 410-843-7451.
Jewish Community Services is a partner in the Jewish Recovery Network, a consortium of organizations providing a continuum of addiction treatment and recovery services that can attend to distinctive needs and issues of individuals and families in the Jewish community.
Learn more at jcsbaltimore.org/addiction or call 410-466-9200.
By Karen James, LCSW-C, JCS Adult Therapy Services