, Newburyport, MA


April 18, 2014

The heroin addiction scourge

Opiate addiction — in particular, heroin addiction — is becoming a worldwide scourge. In the United States, heroin abuse has moved far beyond our inner cities, resulting in a dramatic increase in addiction and death.

The quiet, peaceful and pastoral state of Vermont is in the midst of a devastating heroin crisis. Vermont Gov. Peter Shumlin devoted his entire State of the State address to the addiction problem. In his words: “In every corner of our state, heroin and opiate drug addiction threatens us.”

Massachusetts has also been hit hard by the torment of heroin addiction; 185 people died from heroin overdoses between November 2013 and February 2014.

The current opiate abuse epidemic in America is not entirely new. As early as 1972, drugs were the greatest killers of young people between the ages of 18 and 40 in most major cities in the United States.

While a serious issue, physical addiction is not the primary problem for heroin addicts. While the co-director of a drug addiction therapeutic community associated with Boston City Hospital, I learned a lot about heroin addiction. The real addiction problem is psychological. It is more difficult and more dangerous to withdraw from alcohol and some sleeping pills than it is from heroin.

Despite the longevity and now-acute nature of heroin addiction, we still don’t understand it. One of the major reasons we don’t is that both the professional and lay communities have tended to regard heroin use as a moral and criminal problem. In reality, politically generated public policies have held back really meaningful research that could generate badly needed knowledge. Many prevention and treatment programs are operating on the basis of faulty knowledge and moral preconceptions about drug abuse.

A good example of this is the notorious methadone maintenance programs that first emerged in the early 1970s to treat heroin addicts. “Experts” regarded heroin addiction as a biological disease similar to diabetes. If the diabetic needed insulin to be normal, then, it was argued, the opiate addict needed something to blockade the desire for heroin. Methadone, a powerfully addictive synthetic opiate, was prescribed for heroin addicts. It still is. But methadone “treatment” is a little like “curing” the alcoholic who drinks a 12-pack of beer every day by giving him a quart of rum to drink every morning.

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