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1 Heroin in Indiana It s a Growing Problem Heroin has been showing up on the streets of Indiana in a frequency that makes it the most abused narcotic, even passing cocaine. Sergeant Jerry Goodin, Indiana State Police A recent report to Drug Free Marion County from the Marion County Coroner s Office showed an alarming increase in heroin deaths over the past three years. In 2011, 48 heroin deaths were recorded; in 2012, 77. This year, Marion County already has surpassed the entire 2011 total. As of June 28, 2013, 49 heroin deaths had been recorded. Simply put, Marion County is well on the way to more than doubling the number of heroin deaths recorded in Indiana s status as the Crossroads of America ensures easy interstate access for profitseeking drug dealers. On July 13, for example, police in Des Moines, Iowa seized 11 pounds of heroin valued at $1.3 million the biggest such bust in the city s history. The drug s destination: Indiana, according to Des Moines Police Sergeant Jason Halifax, as quoted in the Des Moines Register ( Des Moines police make largest heroin bust in city s history, Des Moines Register, July 16, 2013) The Indiana State Police report that troopers are extremely alarmed at the rate at which heroin is showing up on Hoosier streets. In 2011, heroin was the second-most purchased drug by Indiana State Police undercover officers, second only to marijuana. Heroin use in Marion County increased 21 percent between 2010 and 2011, according to the Indianapolis Metropolitan Police Department. IMPD also reports that Indianapolis is known as the hub for Mexican drug cartels, due to the city s multiple intersecting interstates and major thoroughfares. Treatment providers report a dramatic increase in clients seeking services for heroin addiction. The Rise in Today s Heroin Use is Often Tied to Prescription Drug Abuse It s hard to talk about the heroin problem without talking about the prescription drug problem. Rafael Lemaitre, White House Office of National Drug Control Policy A growing number of people who start abusing prescription drugs especially painkillers such as Oxycodone are switching to heroin. Prescription drug manufacturers have begun changing the formulations of pills, making them more difficult to crush and then

2 inhale or inject. A study by the New England Journal of Medicine showed that 66 percent of more than 2,500 people with a dependence on OxyContin switched to another opioid usually heroin after OxyContin changed its formula. Heroin is cheaper and more easily available than prescription drugs. A bag of heroin can cost as little as $3 to $10. An 80-milligram dose of OxyContin can cost up to $80 on the street, according to the U.S. Drug Enforcement Administration. For a televised report, NBC News interviewed dozens of former young heroin addicts. Every single one said they started using expensive prescription drugs, then began snorting heroin and eventually progressed to injecting it. Most of them started shooting up within weeks (of first use), the report said. Heroin is Increasingly Being Used by Young People The population that seems to be affected the most by this drug is our young white people. They are coming to our facility on a daily basis. Jamie Brown, Salvation Army Harbor Light Center Detectives are certainly seeing a trend toward the younger, the more educated, the more suburban user of heroin right now. Catherine Cummings, Marion County Office of Public Safety Initiations to heroin have increased 80 percent among 12- to 17-year-olds since 2002, according to the Substance Abuse and Mental Health Services Administration. Close to 90 percent of teen heroin addicts are white. In 2009, the most recent year for which national data is available, 510 young adults between the ages of 15 and 24 died of a heroin overdose. In 1999, that figure was 198. Heroin is a Dangerous Drug It doesn t take much to get hooked on it. Three or four times and you are lost, lost to it forever. Pam Koch, an Indiana mother who lost her 23-year-old son to a heroin overdose Just by using over a week and at a party, it took over my life and just about destroyed my life. A lifelong resident of Lafayette, Indiana who wished to remain anonymous Dosage and exact contents are difficult to determine. Heroin powder is often cut with other chemicals (even rat poison) to bolster profits for the dealers. Heroin also is found in a wide range of purity levels, from 1% to 98%. If a person used to a lower dose suddenly injects a nearly pure dose, an overdose death can occur immediately. (People) don t really know what they re getting, says Theodore Cicero, professor of psychiatry at Washington University in St. Louis. They don t know the dose or the purity, so overdoses become quite common. Heroin is highly addictive. The National Institute on Drug Abuse reports that about 23 percent of individuals who use heroin become dependent on it.

3 Heroin depresses breathing, often leading to fatal overdoses. Other health risks include collapsed veins, infection of the heart lining and valves, abscesses, cellulitis, liver disease and pulmonary complications. Users who inject heroin risk infectious diseases such as HIV/AIDS and hepatitis. What Can Parents/Guardians/Concerned Loved Ones Do? Now we are seeing (heroin) in nicer communities in Carmel, in Zionsville, in nice homes in Lebanon and in Thorntown. It can happen and it is happening here, and if you don t believe it is, you are wrong. You are just flat wrong. Ken Campbell, Boone County Sheriff Look for Behaviors Prior to Use If an individual is dependent upon or addicted to prescription medications, it can lead to the eventual use of heroin. Warning signs for prescription drug abuse include: doctor and/or dentist hopping to obtain additional prescriptions; visits to the emergency room with vague complaints of pain; repeatedly lost prescriptions. Look for Drugs and Paraphernalia Heroin usually appears as a powder ranging in color from white to brown or as a dark brown or black sticky substance known as black tar heroin. Heroin may be packed in a balloon or folded in small foil packets. Paraphernalia used to snort or smoke heroin include razor blades, straws, rolled dollar bills and pipes. Syringes are used to inject the drug. Also look for small cotton balls (used to strain the drug), spoons or bottle caps and cigarette lighters (used to heat the drug) and rubber tubing or a similar tie-off used tightly around the arm to make veins protrude. Look for Behaviors During Use Heroin is a depressant that inhibits the central nervous system. Immediately upon using, a person will have a dry mouth and flushed skin. Someone under the influence of heroin may have constricted pupils and droopy eyelids, and his/her arms and legs can feel extremely heavy and difficult to use. The person may experience nausea or vomiting and feel an intense itchiness all over the body. Further into the dose, users often become sluggish, drowsy and unable to think or function clearly. Heart rate and breathing slow. Look for the heroin nod : the head slumps forward toward the chest, even when the individual is standing. Regular heroin users can have dark circles below the eyes, pasty white skin, constipation and/or loose bowels, depression and decreased sensitivity, especially to pain. Look for Behaviors During Withdrawal Early symptoms of heroin withdrawal include anxiety, agitation, muscle aches, insomnia, tearing of the eyes, a runny nose, sweating and repeated yawning. Late symptoms of heroin withdrawal can resemble those of the flu, including abdominal cramps, diarrhea, dilated pupils, goose bumps, nausea and vomiting.

4 Treating Heroin Addiction It s disappointing to see that increased (heroin) usage, but it s good to see (addicts) showing up here instead of committing criminal activity. Elliott Miller, marketing director for a Valparaiso rehabilitation clinic I made (young funeral visitors) look at my son lying there in his casket and said, This is door number three in drugs. You ve got door number one: a good, clean life. You ve got door number two: you are a heroin addict. There is no door number three. Mike Koch, an Indiana father who lost his 23-year-old son to a heroin overdose Options for treating heroin addiction include: Methadone. Morphine is known as a full opioid agonist it is a synthetic narcotic medication that binds to opioid receptors in the central nervous system and stimulates activity normally stimulated by heroin. This tricks the brain into thinking it is receiving heroin, thus eliminating withdrawal symptoms. In oral forms, it has a slow onset of action, making it generally undesirable as a means of producing euphoria. Properly prescribed, methadone is not intoxicating or sedating, and its effects do not interfere with ordinary activities such as driving a car. The medication suppresses narcotic withdrawal for 24 to 36 hours, so it does not need to be taken more than once daily. Patients are able to perceive pain and have emotional reactions. Most importantly, methadone relieves the craving associated with heroin addiction; craving is a major reason for relapse. It is only available through specialized clinics. Buprenorphine. A recent addition to available medications for treating addiction to heroin and other opiates, Buprenorphine is known as a partial opioid agonist it produces less of an effect in the brain than a full opioid such as heroin or methadone. Like methadone, it tricks the brain into thinking that a full opioid such as heroin has been taken and therefore suppresses withdrawal symptoms. A person who is dependent on heroin will not get a euphoric effect or feel high when Buprenorphine is taken properly. Because it is not a full opioid agonist, Buprenorphine also produces a lower level of physical dependence, so patients who discontinue the medication generally have fewer withdrawal symptoms than do those who stop taking methadone. It can be prescribed in the privacy of a doctor s office, rather than through a methadone clinic. Buprenorphine/naloxone (Suboxone). This combination drug is formulated to minimize abuse. The Buprenorphine (described above) is combined with Naloxone. Naloxone is not absorbed into the bloodstream to any significant degree when Suboxone is taken correctly and allowed to dissolve under the tongue. However, if someone tries to circumvent the therapeutic benefits of Buprenorphine by crushing and then snorting or ingesting Suboxone, allowing it to travel more rapidly to the central nervous system, the Naloxone will go along for the ride and block any opioids from their receptors. Behavioral therapies. There are many effective behavioral treatments available for heroin addiction. These can include residential and outpatient approaches. An important task is to find the best treatment approach that meets the particular needs of the patient. Combination therapy. Although behavioral and medication-based treatments can be extremely useful when employed alone, research has shown that integrating both types of treatments will ultimately be the most effective approach.

5 Treatment Options You have to want to quit, yourself, first and foremost. And when you want to quit you have to have a lot of support from family and friends. Dustin Durham, 20, an Indiana resident and recovering heroin addict Many insurance plans include substance abuse treatment. For a list of treatment providers in Marion County, visit Drug Free Marion County s Treatment Provider Directory on our web site: Those without insurance also have options. In Marion County, they include: The Indiana Access to Recovery Program (INART). This federally funded program assists clients who want to get into recovery or need assistance maintaining their recovery but who cannot afford substance abuse services. To qualify, applicants must have a household income at or below 200% of the Federal Poverty Line (500% for military), must be a legal adult and must meet one of the following target populations: past or present military service, pregnant women, women with dependent children, individuals who have just been released from a criminal justice facility or who are currently involved with the criminal justice system (post adjudication) or individuals who have recently signed an agreement with Diversion Court. For more information, call , or visit Local Recovery Consultant (RC) agencies evaluate individuals for INART eligibility. If the individual is eligible, the RC staff will provide information about area INART treatment providers. The following Marion County organizations serve as RCs: Community Outreach Network Services, Public Advocates in Community Re-Entry (PACE) Inc., , ext. 21 Libertad Counseling, The Way to Recovery, Bethlehem House, Community Mental Health Centers (CMHCs). Community Mental Health Centers accept insurance and Medicaid/Medicare and provide sliding scale fees for those without insurance, based on income and dependents. CMHCs in Marion County include: o Midtown Community Mental Health and Addiction Services. Part of Wishard Health Services, Midtown provides a range of services for those with opiate addiction. The Midtown Narcotic Treatment Program is a methadone clinic. Midtown s other addictions clinics use an approach that combines the use of Suboxone and rehabilitative care. Financial counselors work with clients to determine appropriate methods of payment and help eligible individuals apply for financial aid through various government programs. For more information, call or visit o Gallahue Mental Health Services. Gallahue uses a multidisciplinary team to address chemical dependency. In-patient and crisis services are available. For more information, call (regular number) or (crisis line) or visit

6 o Adult & Child Mental Health Center Inc. For more information, call (regular number) or visit o Aspire Indiana Behavioral Health System. Aspire uses a combined system of medication-assisted therapy and participation in counseling treatment to treat heroin addiction. A maintenance program is frequently incorporated, allowing clients to undergo after care until they establish a significant period of abstinence, independent living and a positive social support system. For more information, call , or visit Salvation Army Harbor Light Center. Here, counselors assess clients to see if they have the qualifiers to meet the official opiate dependency diagnosis. If detox is needed, the Center works on a sliding fee scale with clients who have financial difficulties. For more information, call or visit The Marion County Public Health Department. The Health Department has some available funds for assisting those in need of substance-abuse treatment. Call the Substance Use Outreach Services Program at Fairbanks. Fairbanks offers adolescent and adult treatment and recovery services, including detox and rehab, outpatient treatment, education and recovery management. Adolescents in recovery from addiction may attend Hope Academy, the recovery high school at Fairbanks. Hope Academy is a fully accredited, tuition-free, Indiana public charter high school that provides opportunities for academic achievement, sobriety and personal growth for students and their families. Consistent with the mission and values of Fairbanks, financial assistance will be provided for individuals who are unable to afford treatment services. For more information, call or visit Other Suggestions/Information No matter how upset (learning about my heroin use) made (my mother), I knew she would want what I wanted. I wanted help. Cara, Indiana resident and 18-year-old recovering heroin addict Ask if treatment will be provided or supervised by a Licensed Clinical Addiction Counselor (LCAC). Such an individual is required to hold a master s or doctorate degree in addiction counseling/therapy, must pass a licensure evaluation and must undergo two years of supervised addiction counseling, as well as meet a number of coursework requirements. If a loved one is addicted to heroin and has just entered the criminal justice system for an offense, try to set up a treatment program while the individual awaits the legal system. This will show criminal justice professionals that you know the person has an addiction problem and you are trying to get him/her into recovery. After an arrest, many heroin addicts will be assigned to Courtroom #14, Marion County Drug Court. Judge Jose Salinas often recommends diverting the addict into a drug treatment program.

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