New drugs in the US present hope for addicts who want to give up although heroin usage is increasing in the United States. The usage of illegal drugs has fallen markedly in the United States -- 12.8 million Americans do drugs, half the number in 1979 -- signs indicate the rate of heroin addiction may be increasing. There are 600,000 addicts in the United States (of an estimated 8 million worldwide), but more people are snorting or smoking the drug rather than injecting it, a trend experts ascribe partly to the fact that street heroin is purer and partly to fear of AIDS. The number of hospital emergency-room admissions related to snorting or smoking heroin jumped a staggering 470 percent, from 1,100 to 6,000, between 1988 and 1993, according to a survey by the Drug Abuse Warning Network. The same survey also found that between 1992 and 1993, hero-in-related emergency-room admissions increased by 35 percent among people ages 18 to 25.
That's just the tip of the iceberg: A recent survey by the United Nations put the total amount of trade in illegal drugs at about $400 billion a year, making it a growth industry that rivals the global trade in textiles. With direct and indirect costs of drug addiction amounting to $80 billion every year in the United States alone, it's no wonder that the government is eager to stem the tide. But the war on drugs widely is regarded as a failure: Only 10 to 15 percent of heroin shipments are seized annually (compared with about 30 percent of cocaine). Curbing consumption would seem to be the better bet. Some experts contend that the solution must be based on the use of legal opiate substitutes. But many in the treatment community vehemently disagree, arguing that only abstinence works.
Any cure, however, first must address the problem of withdrawal. Heroin Withdrawal lasts three to five days and causes hot flashes, cramps, nausea and other symptoms so disagreeable addicts will do anything to avoid them. (Opiate Withdrawal seldom is fatal, whereas alcohol withdrawal, if not properly treated, can lead to death.) And because addicts develop a tolerance to the narcotic, they need ever-greater doses of the drug to produce the same high. "Over the last five or 10 years, the scientific emphasis by the government is to employ chemotherapy to treat addiction in a cost-effective manner," says Donald Jasinski, head of the Center for Chemical Dependency at Johns Hopkins University in Baltimore. Washington must spearhead the effort, Jasinski tells Insight, because pharmaceutical companies have no economic incentive to do so. "Most addicts are treated in public settings -- they don't get their drugs in drugstores," he says. Even the nicotine patch was developed as a result of government research.
Most of the common antiaddiction medications are designed to stimulate the limbic system-the part of the brain scientists believe produces the craving for drugs. The brain manufactures compounds known as endorphins that are similar to morphine and heroin. The pleasurable sensations -- some call it a natural high that endorphins create serve as a kind of reward system. These chemicals also help people withstand stress and pain. Some scientists believe addicts suffer from a disorder of the limbic system. That is, these people can't experience endorphin-triggered pleasure, and they are more susceptible to depression. Some heroin addicts actually may take the drug to feel "normal."
"We have a lot of evidence to show that opiate addiction is a neurophysiological disorder and a chronic relapsing disorder," says Edwin A. Salsitz, director of the methadone medical-maintenance program at New York's Beth Israel Medical Center. "People who are opiate-dependent function better on opiates. They will say that they've never felt better. Something goes wrong in the system, either with the production of the chemicals or with the ability of the receptors to receive them or with the interconnection. They are suffering from an endorphin dysfunction." To get opiate addicts to feel and function normally Salsitz treats his patients with methadone, a synthetic analgesic first produced by scientists at Rockefeller University in New York more than three decades ago. It remains the most common treatment for heroin addiction. Methadone also has the advantage of being cheap: An 80 milligram dose costs less than $1 and lasts for about 24 hours. In most cases, it has few if any side effects, though in high-enough doses it can depress respiration and cause death.
"People have accepted Prozac -- they don't think that patients taking it for depression are bad people," Salsitz tells Insight. "But in America there's an opioid phobia -- that no one should be taking drugs, whatever the reason. This attitude spills over into effective pain management [for illness] by physicians. Doctors are afraid to make patients dependent on drugs." Drug dependency, however, is not necessarily a terrible thing, argues Salsitz. "If you don't get opiates, you will go through withdrawal. On the other hand if you are taking insulin for diabetes and give up insulin, you will have trouble. That's part of the deal. You don't become addicted to methadone -- you become drug-dependent." These methadone patients who are functioning normally are doctors, electricians, plumbers and window washers who work on skyscrapers.