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How Heroin Became a Gateway Drug

How do you picture a heroin user? Once thought to be a drug strictly abused by artists, musicians and the down-and-out, the image of this extremely addictive opioid has begun to change. In recent years, the availability of heroin has increased rapidly in suburbs, rural areas and affluent communities like never before.

“It’s more available, more acceptable,” says Dr. Deni Carise, Chief Clinical Officer of the Recovery Centers of America and Adjunct Clinical Professor at the University of Pennsylvania. “This is something that average Americans now do, not just musicians or artists or people on the street.”

In 2005, according to a recent study, 8.7% of first-time opioid users started with heroin. In 2015, that number leapt up to 33%, suggesting a dramatic shift in the way Americans approach narcotics.

“It used to be that somebody addicted to heroin generally had a long history of varied drug use leading up to that,” says Dr. Carise. “The last few years, we have seen people who were drug naive six months ago, and are now shooting heroin. That never used to be the case.”

The cause, Dr. Carise says, is complex. Two driving factors are the decreased availability of prescription painkillers and a surge in production by Mexican cartels who are expert not just in producing and smuggling heroin, but also in marketing it.

Since the advent of the prescription opioid epidemic, doctors have been forced to reevaluate how they prescribe painkillers. That new approach, coupled with statewide Prescription Drug Monitoring Programs that make it harder for a single patient to receive unneeded prescriptions from multiple doctors, means that prescription opioids are not as freely available as they were five to 10 years ago.

Heroin is Readily Available

Heroin, however, is more available than ever. Ninety percent of the nation’s heroin comes from Mexico, where cartels have made fortunes through innovative marketing and distribution strategies. Rather than target urban areas already dominated by American dealers, they expanded into new markets, offering boutique delivery service that made heroin more palatable to middle and upper-class clients.

“They deliver to you, they call to follow up to see if you need more,” says Dr. Carise. “It’s very customer service oriented, and has the appearance of being less risky.”

Of course, heroin is never actually low-risk, and its increased use and prevalence, particularly among the recently-drug naive, presents unique challenges for Dr. Carise and her colleagues at RCA. First-time opioid users starting off with heroin tend to hit rock bottom quickly, making treatment easier or harder, depending on the case.

“It gives us a unique opportunity to say, ‘Look how quickly this addiction affected your life,'” says Dr. Carise. “On the other hand, because the problem was short-lived, it is difficult to get them to buy into long-term recovery.”

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