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Drug enforcement agencies, health pros see increased use of heroin

POSTED: December 7, 2013 11:47 p.m.

Jose Galaviz was abusing drugs, including injecting heroin, when he wound up in the Hall County Drug Court program after being presented with two options.

“It was a brand new program for Hall County — it was either that or 35 years in prison,” he said.

Galaviz was at first a reluctant participant in the alternative sentencing program in its inaugural year under former Superior Court and Senior Judge John Girardeau.

“I had a real rough time the first six months. I kept having positive drugs screens — I basically couldn’t stop,” he said. “It was hard. Even though I wanted to quit, addiction just totally takes over you.”

After graduating the program and conquering his addiction, Galaviz became a certified drug counselor. Now a substance abuse treatment professional, he cited a trend concerning public health officials for years: Increased heroin use.

“I think that as pain management clinics started to come in to the state, I did see an increase in abuse of those drugs — Oxycodone, Oxycontin,” he said. “I started seeing young adults crushing them — you can snort it, smoke it, eat it, inject it. That stuff is extremely addictive.”

But as addiction took hold, some clients reported more extreme measures, leading to heroin.

“If they cannot get Oxycodone — either because there is none around, or their dealers run out, or they run out of money because they run for $35 to $40 apiece — if they have the ability to get heroin, they go for it,” Galaviz said.

The Hall County-Gainesville joint drug task force, the Multi-Agency Narcotics squad, reported eight heroin arrests in 2013, compared to just one each yearly 2009 through 2012.

Lt. Scott Ware, who heads the MANS unit and has 20 years of drug enforcement experience, said it was a stark increase.

“Up until this year, I don’t think I’d seen heroin twice,” Ware said.

Arrestees by the MANS unit were as young as 17, up through middle-aged adults, Ware said.

Heroin arrests statistics are not tracked by the Hall County Sheriff’s Office or the Gainesville Police Department. The GPD keeps statistics on the combined arrests for possession of opioids or cocaine, which rose from 35 in 2012 to 63 in 2013 through November.

According to the National Institute on Drug Addiction, in 2011, 4.2 million Americans aged 12 or older (or 1.6 percent) had used heroin at least once in their lives. The federal agency estimates that about 23 percent of people who use heroin become dependent on it.

Effects are similar

Like Galaviz, Ware cited economics as one of the reasons prescription pills may lead to street opioids.

“From my understanding, talking to people, a lot of them start with Oxycodone and find that heroin provides a similar type high,” Ware said. “It has similar effects and actually becomes cheaper and easier to obtain heroin than Oxycodone. That’s a trend that we’ve seen probably over the past year.”

Dr. Vinay Nagaraj, a Gainesville psychiatrist with a fellowship in addiction at Emory, explained the two drugs are almost chemically identical, creating the similar effect.

“Pharmacologically, they’re almost identical. Prescription narcotics act on the opiate receptors, or pleasure receptors,” he said. “Prescription narcotics are essentially heroin in a pill form.”

But he stressed that one is legally distributed and one is not for a reason: their potency.

“Heroin binds with opiate receptors to a much stronger degree — it’s a much stronger binding affinity,” he said. “A prescription pain pill acts on the same receptor, but is not nearly as strong. That’s why heroin is much more addictive.”

Opioids activate the “reward center” in the brain, he said.

“When you’re abusing these drugs, the opiate receptors are always occupied — euphoria, pleasure, happiness, pain relief,” Nagaraj said.

As a treatment provider for Northeast Georgia Medical Center’s mental health services, Nagaraj also has observed an increase in heroin abuse.

“I think just the general phenomenon of heroin use — heroin abuse — is something that is back on the rise again,” he said.

He said abuse has fluctuated with health initiatives.

“Heroin addiction was very rampant several decades ago, then through the 1980s and 1990s it sort of dipped down as there was a large push to combat HIV and that illness through sharing needles,” Nagaraj said. “Ever since about the mid-2000s, it’s been back on the rise again.”

Nagaraj cited patients who made the pill-to-heroin transition as well, and other factors that could explain the increase in heroin abuse.

“Today, the form of heroin available is generally more pure, more addictive, so those who try it for the first time become addicted more quickly. It’s also more accessible; it’s cheaper,” he said.

Nagaraj said there are important distinctions when it comes to taking prescription opioids, and what is appropriate and what is not.

“It’s not necessarily wrong to take prescription pain pills. A lot of people take prescription pain pills, and they might become physiologically dependent,” he said. “That’s not something to be overtly worried about. The way a medicine works, especially prescription drugs, you’re likely to become dependent on it, and you have to be tapered off — that doesn’t mean you are addicted.”

Addiction, unlike physical dependence, speaks to behaviors and choices driven by the drug use, he said.

“It’s where over a period of time, you tend to increase use, find alternative ways to get the drug, commit crimes to fund your drug habit,” he said.

While drug addiction is possible after just one use, typically it’s a longer process, he said.

“I have had patients who stated they used one time and that was it, but more often you hear of gradual use that escalates,” Nagaraj said.

Overdosing an extreme danger

Galaviz said that tolerance causes opioid use to approach dangerously high amounts.

“One of the things about heroin or pain killers and opiates, is that the dose that you need to get high is real close to the dose you can overdose with,” he said. “Depending on your tolerance levels — how much you’ve been using and how often — that pushes the body and every time you do it you need more and more.”

Heroin is most associated with overdoses through needle injection, Nagaraj said.

“It’s a much quicker onset of action, and there’s less regulation on the amount — you don’t know how much you’re taking in,” he said.

People who have relapsed into using heroin can be more vulnerable to overdose, Nagaraj said, as the body is unequipped to handle previous amounts.

Overdosing on any opioid can suppress breathing and cause death, he noted, a major reason for the public health push to curb prescription drug abuse.

Heroin dependency can prompt severe withdrawal symptoms if a person quits cold turkey, Nagaraj said.

“Muscle cramps, nausea, vomiting, diarrhea. You can experience hot and cold flashes, extreme cravings,” he said. “That’s the time period when people are most susceptible to using.”

Galaviz likened withdrawal to the flu — only worse.

“Everything hurts. It’s like one of those flus where all your body aches, but times 100,” Galaviz said.

Drugs sought to fill emotional void

After initially relapsing during drug court, Galaviz said, the judge ordered him to spend 30 days in jail as a preview of his bleak future if he couldn’t beat his addiction and complete the program.

“I guess you could say that was the one push I needed,” he said.

To prevent abuse, early and comprehensive prevention education in schools is important, Galaviz said, as well as having a healthy home life both physically and mentally.

“We all know about physical nourishment — food, buying clothes — but we also need that emotional nourishment from our parents,” he said, including open lines of communication. 

“In my experience — it’s not an absolute — but a lot of times when someone has a substance abuse issue they were emotionally hurt in some way as children.”

On the enforcement end, Ware said his unit works to understand and investigate drug trends with the people who know it best.

“The best and the real sources are the people out there selling and using the drugs. You’ll find your most accurate information and often they’re willing to talk about it,” he said.

But the unit is playing a bit of catch-up as it comes to understand more about the drug and its infiltration.

“This is so new, it’s been a little bit of a learning process for us, honestly,” Ware said.


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