Heroin Conference Notes

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Heroin Use and Addiction:
A National Conference on Prevention,
Treatment, and Research
September 29-30, 1997
Washington, D.C.

Sponsored by the National Institute on Drug Abuse
and the
National Institutes of Health

Reported by
Sergeant Thomas E. Page
Los Angeles Police Department

This conference consisted of a series of panels and workshops on issues related to heroin use and treatment. The presenters were primarily researchers and representatives of the National Institute on Drug Abuse. The following summarizes the major points that were made by the presenters throughout the conference. These summarizes were compiled from notes taken during the presentations.

OVERALL TRENDS

Nationwide, Heroin supply is up, purity is up (but is variable from region to region), and cost is down
Some researchers say the overall purity is now averaging 36%, whereas others claim it averages 68% and may go as high as 80%
Government drug strategies will include law enforcement, treatment and prevention, and a greater focus on the demand end of the supply/demand continuum
Half of the 1.6 million in US prisons are there for drug-related crimes

DOSING AND METHODS OF ADMINISTRATION

Increased purity allows it to be effectively ingested intranasally (medicine droppers are frequently being used to place the liquid in the nose)
I/V use is stable, but intranasal use is increasing
Intranasal use has an onset of action just about as fast as I/V. At the same dose, however, the effects are less intense. 50 mg I/V = about 100 mg intranasally
Poly-drug use and poly-drug dealing ("double-breasted dealing") are increasingly popular
In New York City, the typical I/V heroin dose is about 50 - 100 mg

USER TRENDS

Heroin use is up particularly among the young
Most new heroin users are under 26 years old
More 8th graders today are using Heroin than are 12th graders
Most drug use starts in the teens
Very few young African Americans are using Heroin
Gender gap has narrowed, in that more females are using heroin

SUPPLY ISSUES

600,000 Heroin addicts in the US, using 10 metric tons of heroin annually
USA uses 2%of the world's total supply of heroin
Burma produces 60% of the world's total supply of heroin
Mexico produces 5% of the world's total, and dominates the Western USA(tar and brown powder)
La EME (Mexican mafia) and the Black Guerilla Family (BGF) are primarily responsible for Mexican heroin, which is "couriered" into the USA in small quantities

METHADONE, LAAM, AND TREATMENT ISSUES

Criminal activities should diminish with increased use of Methadone and LAAM (l-acetyl-alpha-methadol, trade name of Orlaam)
Most heroin users overcome the addiction, unless they die. Suicide is a risk factor for heroin users
People who get treatment through criminal justice system sanctions have about the same success as those who enter voluntarily!!
If Heroin is taken with methadone, a very large dose (100 to 200 mg) is required to achieve any narcotic effect. Increased doses of methadone (60-120 mg a day) will have improved effectiveness, with less likelihood of other opiate use
California is "notorious" for under-prescribing methadone
The "dose" of supporting psycho-social services is also important in methadone treatment.

GATEWAY ISSUES

Marijuana use doesn't invariably lead to Heroin or cocaine, but is a necessary condition for progression to more serious drugs
The earlier the age of use of tobacco and alcohol, and the more frequent the use of marijuana, the greater the likelihood the individual will use heroin

PHYSIOLOGY

Heroin destabilizes the brain's Dopamine reward systems, whereas methadone stabilizes the system
No euphoria is generally experienced with Methadone
With time, the Heroin user's brain becomes chemically and physically altered!! (Dopamine cells in the brain shrink in response to chronic Heroin and Morphine use)
Chronic exposure to opiates causes changes to the brain, including a reduction in neurofilaments (these transport chemicals from the cell body to the synapse), and the shrinkage of dendrites
Heroin inhibits the neurotransmitters that inhibit Dopamine, thereby increasing Dopamine and its positively reinforcing effects
Withdrawal is a negatively reinforcing effect. "Craving," which is an irresistible urge and a compulsion to use, is a conscious expression of brain changes
Methadone doesn't block alcohol and cocaine use
The opiate antagonist, Naltrexone, blocks opioid receptors, and produces no Withdrawal and no development of Tolerance
Most addicts, however, are reluctant to use naltrexone

DRE EFFECTS

Heroin has minimal effects on performance, including divided attention, at lower doses (Note: The supposed lack of effect on performance was challenged during the discussion period.)
Heroin has both sedative and euphorogenic effects
Opiates produce euphoria, suppress coughing, decrease breathing, increase vomiting and nausea, decrease intestinal activity, decrease anxiety, and increase sedation

DISEASE, HEALTH AND SOCIAL COMPLICATIONS

Primary major health problems of Heroin are: HIV, STD, TB, and Hepatitis.
Up to 50% of I/V drug users in New York City are HIV positive
Virtually all I/V drug users are positive for Hepatitis C (HCV)
HCV causes 10,000 deaths a year in the USA. Progression of HCV is about 20 to 30 years. 60 to 70% of HCV cases come from I/V drug use.
Social consequences of Heroin use include increased mortality, increased morbidity, increased crime, deteriorating health, including mental health, decreased social functioning, including a downgrade in economic status, and an increase in psychological problems