University Times

Asked whether they knew anyone — neighbors, family or friends — with an opiate addiction, half the 60 people attending the Staff Association Counsel’s May 24 presentation on opiates raised their hands.

As panelist Nancy McKee pointed out, addicts are no longer as hidden as they used to be, thanks to widespread painkiller over-prescription, which leads to addictions and then to use of the chemically related but cheaper and more readily available heroin: “Those are people that we know. Those are people that we live next to. Those are our children.”

McKee, clinical manager for the UPMC health and wellness program LifeSolutions, reported a 208-percent increase in overdoses from pain medication in Allegheny and seven surrounding counties from 2008 to 2014, and a 289-percent increase in heroin overdoses in the same area and time.

Pitt Police Sgt. Charles Welsh noted that the total number of pain relievers prescribed in the United States grew from about 76 million in 1991 to 207 million in 2013 — and 80 percent of new heroin users started by abusing prescription opioids.

Heroin on the street now is as much as 70 percent pure, he said, compared to a 2-3 percent pure product used in the 1970s, making overdoses more likely today, particularly if addicts use the drug again after a period of attempted recovery.

Opiate addiction causes crime to fuel the habit, Welsh said, particularly thefts, with addicts more likely to be arrested for burglary, retail theft, robbery or receiving stolen property.

“Even right here in Oakland, we get a lot of times where we stop a car and they have bubbles or bricks of heroin in the car,” he said, referencing larger quantities of heroin, as opposed to the postage-stamp-sized “stamp bags” sold individually on the street for about $10.

“We’ve had a problem with theft here on campus,” he added, something he attributes to non-students looking for items to sell for drug money.

Common targets include laptops and cellphones left unattended at Hillman Library. But the Pitt Police also have seen a bicycle theft ring and smash-and-grab thefts from cars parked in Soldiers and Sailors and O’Hara garages. He said Oakland also has experienced violence among drug dealers for control of sales territory.

Robbery and similar crimes are not common at the regional campuses and, if they occur, are more likely to be student-on-student crimes, he said.

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Paying for drugs has taken on a very modern cast, said panelist Rebekah Sedlock, a coordinator with Community Care Behavioral Health. Drug dealers may barter with users who don’t have the cash for their drugs: Dealers may borrow a user’s car or have the user work as a driver, in lieu of payment. Some drug dealers also take checks and use credit card-swiping devices and apps on their mobile phones, listing the transaction as a legitimate business deal and paying taxes on it. But some people do pay for their addictions via thefts or prostitution, she allowed.

How do people end up so addicted that they must resort to crime to pay for their habit? Addiction comes on gradually, Sedlock pointed out. There are five common stages:

• Experimentation: Trying various addictive substances, and perhaps developing a preference for one particular drug or kind of alcohol because it slows the body’s systems down or speeds them up in a desirable fashion.
• Regular use: Beginning to develop a habit.
• Risky use: May be everything from drinking at a work lunch hour to upping the frequency and level of drug use.
• Dependence: The body and/or mind becomes dependent on a substance and there is an anxiety about not being able to obtain the drug, plus withdrawal symptoms if the drug is not used.
•  Addiction: “They’re not using it to get high anymore; they’re using it not to feel sick,” Sedlock said.

Heroin and painkillers may be abused by injection, dissolved under the tongue, snorted or freebased (heated and inhaled through a pipe) or through skin popping (injecting the drug anywhere under the skin, when a vein is hard or impossible to find, or when the addict is too eager for the dose to search for a vein).

Users build a tolerance to opiates, “so you’ll use more and more of it to get that feeling, to feel good,” she added. Some of her clients have used up to 50 stamp bags of heroin per day. “You have to keep in mind that drug dealers are not fine, upstanding citizens” and that heroin may be cut multiple times with several diluting or enhancing substances before it reaches the user. “While they’re using 50 bags of heroin, the amount of heroin they’re using may not be enough for 10 bags” of pure heroin.

Opiates can cause many side effects that may be mistaken for the symptoms of fatigue, from impaired coordination to muscle relaxation. But several symptoms are unmistakably from opiates: constricted pupils and gray skin color. People on opiates also may seem to absentmindedly stroke or scratch the side of their faces.

Psychologically, opiates have a variety of effects: decreased anxiety, cognitive impairment, euphoria or dissociation.

Unlike alcohol addiction withdrawal, which can cause death, opiate withdrawal is not fatal but can cause tremors, seizures and the elevation of many vital signs (blood pressure, pulse and temperature), with nausea and vomiting.

Said another panelist, Tom Koloc, senior account manager for LifeSolutions: “I’ve heard people say if you’re withdrawing from opiates you’ll wish you were dead.”

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Naloxone was developed to bring OD victims back from the brink of death via an injection or a nasal spray. “It throws people into an immediate withdrawal,” said Sedlock. However, she cautioned, “It is not going to help anybody get clean.”

It also must be administered again if it wears off, which is possible within 20-60 minutes. People present at an overdose are advised to call 911 and try mouth-to-mouth resuscitation first.

In fact, said Welsh, anyone near a person overdosing on opiates has just 10 minutes or less to administer naloxone before the victim stops breathing and goes into cardiac arrest, depending on the concentration of the opiate and what it was mixed with. All Pitt officers are trained to administer the drug.

The panelists noted that, thanks to a Pennsylvania law, anyone can go to a pharmacy to request naloxone to have on hand; however, the drug has a short shelf life and not all pharmacies carry it.

Suboxone, a drug that contains naloxone, now is being used to wean addicts from opiates, usually for a two-year course. Recently, insurance companies have begun requiring concurrent treatments with a Suboxone prescription, such as counseling to get addicts past the psychological triggers for drug use.

The panelists also advised that those with current opiate prescriptions keep the medication hidden, since people visiting the home, and even family members, may have an opiate problem and help themselves to another person’s medications.

McKee likes to remind people with opiate abusers in the family: “You didn’t cause it. You can’t control it.” It’s up to the addict to take control him- or herself.

—Marty Levine 

LifeSolutions (www.hr.pitt.edu/lifesolutions) offers free, confidential services, including up to six counseling sessions, to all members of Pitt employees’ households and is available all day, every day for crises requiring urgent attention at 1-888-647-3432.