9781422279656

The Heroin Crisis

Chronic Pain and Prescription Painkillers The Dangers of Drug Abuse The Heroin Crisis Preventing and Treating Addiction Who Is Using Opioids and Opiates?

The Heroin Crisis

John Cashin

Mason Crest Philadelphia

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Broomall, PA 19008 www.masoncrest.com ©2018 by Mason Crest, an imprint of National Highlights, Inc.

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Printed and bound in the United States of America. CPSIA Compliance Information: Batch #OPO2017. For further information, contact Mason Crest at 1-866-MCP-Book. First printing 1 3 5 7 9 8 6 4 2 Library of Congress Cataloging-in-Publication Data

on file at the Library of Congress ISBN: 978-1-4222-3825-7 (hc)

ISBN: 978-1-4222-7965-6 (ebook) Includes bibliographical references and index. ISBN 978-1-4222-3337-5 (hc) ISBN 978-1-4222-8622-7 (ebook)

1. Southwestern States—Juvenile literature. 2. Arizona—Juvenile literature. 3. California—Juvenile literature. 4. Nevada—Juvenile literature. I. Title. F785.7.L37 2015 979—dc23 2014050200

O PIOIDS AND O PIATES : T HE S ILENT E PIDEMIC series ISBN: 978-1-4222-3822-6

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Table of Contents 1: A Growing Crisis ......................................................7 2: A Short History of Heroin ....................................15 3: The Pill Problem ....................................................27 4: Drug Cartels and Heroin ......................................35 5: What Can Be Done? ..............................................49 Series Glossary of Key Terms....................................58 Further Reading ........................................................59 Internet Resources ....................................................60 Index ..........................................................................62 Photo Credits/About the Author..............................64

Words to understand: These words with their easy-to-understand definitions will increase the reader’s understanding of the text while building vocabulary skills.

Sidebars: This boxed material within the main text allows readers to build knowledge, gain insights, explore possibilities, and broaden their perspectives by weaving together additional information to provide realistic and holistic perspectives. Educational Videos: Readers can view videos by scanning our QR codes, providing them with additional educational content to supplement the text. Examples include news cover- age, moments in history, speeches, iconic sports moments and much more!

Text-dependent questions: These questions send the reader back to the text for more careful attention to the evidence presented there.

Research projects: Readers are pointed toward areas of further inquiry connected to each chapter. Suggestions are provided for projects that encourage deeper research and analysis. Series glossary of key terms: This back-of-the-book glossary contains terminology used throughout this series. Words found here increase the reader’s ability to read and comprehend higher-level books and articles in this field.

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Words to Understand in This Chapter

narcotic— a drug that in small doses dulls the senses, relieves pain, and induces sleep, but in larger doses can depress breathing and heartbeat. neurotransmitters— chemicals that are released at the end of a nerve and carry messages to other parts of the body. synaptic cleft— a microscopic gap between neurons. The nervous system uses neurotransmitters to send messages across this gap. synthetic— a substance that is created in a laboratory by blending chemicals. Synthetic substances often imitate a natural product. withdrawal— a syndrome of physical and emotional symptoms that a person addicted to heroin or opioids experiences when the person stops using the drug.

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Heroin is an illegal drug that is often sold as a refined brown or white powder. At one time, heroin was generally considered one of the most hardcore drugs. However, in recent years the street price of heroin has dropped while the purity has increased, making it more appealing to young recreational drug users.

A Growing Crisis

S ince the year 2000, more than 500,000 Americans have died from drug overdoses. More than 60 percent of these deaths involved a class of narcotic drugs called opioids. The opioids include illegal drugs like heroin, as well as other drugs that are legally prescribed as painkillers, such as oxycodone, hydrocodone, codeine, and fentanyl, among others. Public health officials agree that the United States is facing a major crisis when it comes to heroin and other opioids. According to 2017 data from the Centers for Disease Control (CDC), heroin-related overdose deaths more than tripled between 2010 and 2015. In both 2015 and 2016, approximate- ly 13,000 Americans died from heroin overdoses. The CDC also found that the rate of overdose death related to other opioids has increased greatly over the past few years.

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The Heroin Crisis

A bag of fentanyl pills seized in a DEA raid. Because Fentanyl causes effects similar to heroin, it is sometimes blended with low-grade heroin to make it more potent.

From 2014 to 2015, the number of deaths involving synthetic opioids rose by more than 72 percent, to nearly 10,000 deaths a year. One opioid in particular, fentanyl, is credited by the CDC for driving up the death rate. Fentanyl can be fifty to one hundred times more potent than heroin sold on the streets. How Does Heroin Work? Heroin and other opioids work by affecting the user’s brain and central nervous system. The cells of the nervous system, called neurons, that transmit directions from the brain to dif- ferent parts of the body. There are approximately 100 billion neurons in the brain alone. However, the neurons do not actu-

A Growing Crisis

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ally touch each other. Neurons are separated by a gap, called a synapse or synaptic cleft. For messages to cross the synapse, the neuron must release a chemical called a neurotransmitter , which crosses this space to the adjacent neuron. The neurotransmitter binds to a special port on the surface of the neuron, which is called a receptor. Each receptor on a neuron can recognize a specific neurotrans- mitter—the two of them fit together. In a way, this is like the charging cable for a digital device. If you don’t have the right type of plug, it won’t connect. The same thing is true for neu- rotransmitters and receptors. They need to be the right “match” or they won’t be able to recognize each other and take the next step. When a neurotransmitter binds to a receptor, it will either produce an effect or it will inhibit an effect in the neuron. When opioids enter the brain, the neurons mistakenly think they are neurotransmitters because they fit into certain receptors. The drugs overwhelm the neurons in the brain, producing effects that are similar to (but stronger than) those produced by the neurotransmitters endorphin and enkephalin. Heroin also binds to receptors on neurons in the brain stem,

Educational Video

Scan here to see how opioid drugs interact with receptors in the brain and nervous system:

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The Heroin Crisis

which controls important processes, such as blood pressure and breathing. As a result, the effects of heroin include:

• increased analgesia, or reduction of pain sensations; • feelings of pleasure, relaxation, and decreased alert- ness; and • slowed respiration (breathing) and heartbeat. The effects of heroin depend on several factors. These include how much of the drug a person takes, and the way in which the drug is administered. Heroin acts faster, and its effects are stronger, when it is injected. If the user sniffs (“snorts”) a powdered version of the drug or inhales vapors after heating or smoking heroin, the drug takes longer to reach the brain and its effects are weaker. The synthetic opioid fentanyl tends to depress a person’s respiration much more than heroin. This increases the risk of an accidental overdose. Sometimes, fentanyl is added to low- quality heroin to increase its potency. In other cases, a person

Did You Know?

Scientists have found three types of opioid receptors on the nerve cells. They are named after letters in the Greek alphabet—mu, delta, and kappa receptors. Each of these receptors plays a different role. For example, mu receptors are responsible for opioids’ pleasurable effects and their ability to relieve pain.

A Growing Crisis

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Drugs alter the way people think, feel, and behave by disrupting communication between nerve cells (neurons) in the brain. Neurons are separated by small spaces called synapses. Messages are passed from cell to cell across the synapse by specialized molecules, called neurotransmitters, which bind to receptors on the nerve cells. Prescription opioids and heroin produce effects that are similar to—but stronger than—those produced by the neu- rotransmitters endorphin and enkephalin: reduced pain, decreased alertness, and slowed respiration.

may think they are buying heroin when they are actually receiving pure fentanyl. If a person who is used to shooting up a certain quantity of heroin takes the same-size dose of fen- tanyl, death from overdose is nearly certain. Another side effect of opioids like heroin and fentanyl is that people who use these drugs regularly develop a physical

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The Heroin Crisis

dependence on them. As a user’s nervous system becomes used to regular doses of the drug, it stops naturally producing the neurotransmitters. This means the user must take larger amounts of the drug in order to achieve the same euphoric effects. In addition, if the user tries to stop using an opioid he or she will suffer from unpleasant physical effects, known as withdrawal . These generally include severe headaches, uncon- trolled trembling, chills, pain and muscle spasms, insomnia, diarrhea, and vomiting. Some people experience nightmares, hallucinations, and depression. The symptoms of withdrawal can last for several weeks, and most addicts will do nearly any- thing to avoid them. Causes of the Crisis The present heroin crisis has been fueled by two important developments. One of them was the recognition by law enforcement officials and medical practitioners that there was a growing problem with abuse of opioid painkillers. Doctors began to reduce the number of prescriptions they wrote for opi- oids, and police began to crack down on illegal operations that sold the painkillers. But reducing the supply of opioid painkillers meant that patients who had become addicted to the drugs had to find other ways to get high. The second important development was the greater avail- ability of illegal heroin on the streets of cities and towns throughout the United States. Although the U.S. government has been waging a “war on drugs” since the 1960s, it has been unable to prevent illegal drugs from being smuggled over the borders. This is largely due to the rise of well-organized and

A Growing Crisis 13

well-financed drug selling operations, often referred to in the media as drug cartels . Since 2005, drug cartels in Mexico have increased the amount of heroin that they produce each year, and have also increased the purity of the drugs. As a result, the American black market has been flooded with a supply of cheap, pure heroin. Consequently, heroin became an inexpensive substitute for people who were addicted to painkillers but could no longer get prescriptions for them. At the same time, growing numbers of young people are trying heroin and becoming addicted.

Text-Dependent Questions

1. Approximately how many Americans die annually due to heroin overdos- es? 2. What synthetic opioid is credited with driving up the overdose death rate? 3. What factors affect how strongly the effects of heroin are felt by users?

Research Project

The National Center for Health Statistics at the Centers for Disease Control and Prevention does collect information on many of the more com- monly used drugs. Visit their website: www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates and find information about the number of heroin and opioid overdose deaths each year since 2002. Using this data, create a bar chart. Share the information with your class.

Words to Understand in This Chapter

demographics— statistical data relating to the population and particular groups within it. impurity— something that contaminates or taints a product. laudanum— a solution that contains alcohol and opium, which was used as a painkiller from the fifteenth to the nineteenth centuries. prevalence— the degree or rate at which something happens. synthesize— to create something by combining elements or chemicals into a single solution.