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Karen Miotto, M.D., is an Associate Professor in the Department of Psychiatry and Behavioral Sciences at the UCLA School of Medicine. The National Institute on Drug Abuse (NIDA) funds her research in medication development for addictive disease.
"Heroin addicts die at a rate of about 5% per year. That's the highest death rate among any other addiction."
According to Dr. Karen Miotto, heroin is a highly addictive drug due to the euphoric effects and physical dependency it causes. "There is a negative and positive reinforcement with heroin addiction," according to Miotto. The positive reinforcement is the users' experience while under the influence. The negative reinforcement is that once they become dependent on it, they become very sick when they stop." This sickness can drive people to seek more drugs and continue abuse.
Miotto explains, "Heroin addiction is really a lifestyle. Once users cross the line (into dependency), they use the drug every day…and have to procure significant amounts of money to support their habit." It's this daily need to raise funds that, Miotto says, leads many users into personal and/or family neglect, as well as criminal activity.
In treating heroin addiction, detoxification, which can be done on an in- or outpatient basis with different medications, is the first line of defense. Miotto says, "We attempt detoxification in a treatment setting (because) going cold turkey and detoxifying oneself is seldom successful due to the severity of withdrawal symptoms - including nausea, vomiting, diarrhea, muscle pain, bone pains, anxiety, inability to eat and insomnia." Detoxification in treatment eases these physical effects while slowly weaning the body from heroin over the course of a few weeks to months, with the ultimate goal of sobriety.
"If users have attempted detoxification at least once and have been addicted to opiates for a year, they may be able to participate in maintenance treatment," Miotto says. Maintenance treatment seeks to stabilize users with alternate drugs like methadone. "Methadone is taken orally, and people don't experience withdrawal until 24 hours after their last dosage. The difference between methadone and heroin is that methadone only needs to be taken once a day, so ideally users have time to go back to school, take care of their kids, and go to work."
Maintenance treatment also helps users avoid relapse by blocking the physical effects of heroin. Those who inject heroin while on methadone don't experience the euphoria normally induced by heroin.
Because methadone is an opiate and has addictive qualities of its own there is a market for it on the street. In fact, methadone has a street value that ranges anywhere between fifty cents to a dollar per milligram. (According to the White House Office of National Drug Control Policy, the average price of a milligram of heroin in Los Angeles is between twelve and fourteen cents.) Miotto says, "Under the new SAMHSA (Substance Abuse and Mental Health Services Administration) regulations, treatment clinics are required to work with local law enforcement and community agencies to prevent methadone from being re-sold on the street." According to Miotto, certain monitoring is required to ensure that the people who take the drug are really taking it, and not just holding it in their mouth so they can walk out of the center with it. Patients are also tested to ensure that they are taking their methadone.
Miotto underscores the importance of heroin treatment by reflecting, "I think it's important to realize that heroin addicts die at a rate of about 5% per year. That's the highest death rate among any other addiction. They die from infectious disease, from overdose - which is a real risk with heroin, as well as suicide, homicide, and crime-related behavior." Miotto maintains that treatment can allow people to continue with their lives and help prevent family and personal neglect.
To learn more about heroin, click here.
For more information about treatment, click here.
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