Consultant: Heroin addicts are finding new ways to use

Jim Collins, a gerontologist, consultant and author from Youngstown, presented a continuing education program on “Death by Heroin” at East Ohio Regional Hospital Wednesday. In attendance were nurses and officials from area hospitals and nursing homes.

Ohio is one of the top five states in the country for heroin-related deaths, according to Collins.

“It’s right here in the heart of it all,” he said.

Offering a theory on why Ohio is such a prime spot for drug traffickers, he said, “We have a very good highway system.” The majority of heroin enters the United States from Mexico and Afghanistan, he added.

Unintentional drug overdose deaths have increased significantly nationwide.

There were 1,914 such deaths in Ohio in 2012, but that number has grown dramatically.

Reportedly, 120 drug-related deaths occur daily in the state, Collins said.

Fatal overdoses happen most frequently in the northeastern and southern parts of the Buckeye State, according to Collins.

The problem is so prevalent that trailers serve as temporary morgues in hospital parking lots because morgues are overflowing, he said.

Adding to the innate danger of heroin, users lace the drug with “really horrific medications” such as carfentanil — the so-called “elephant tranquilizer” used by zookeepers.

Collins said this substance is 10,000 times more powerful than morphine and stops the heart within a minute.

Collins provided the gathered health care professionals with a list of physical symptoms of heroin addiction and advised them to look for less-obvious signs, too. He said, “Most people are not shooting up these days. They don’t want to leave marks.”

Some users insert a needle sideways under the skin — instead of injecting in a vein — to create a time-released bubble of heroin, he said.

With addicts also injecting heroin by needle into the mucus membrane under the eye, Collins said, emergency room personnel should look for signs of eye infection, irritation, excessive tearing and scar tissue.

He also described a practice known as “booty bumping,” in which addicts insert heroin in the anus, causing the drug to take effect quickly. With no outward signs visible in these patients, he said, “In the ER, you (nurses) can’t find a point of entry. You don’t know what is going on.”

Regarding recovery, Collins said it is essential to get addicts to believe — not just admit– they have a problem and seek treatment. Studies show court-ordered treatment is as effective as voluntary treatment, he added.

Explaining the process, he said, “Detoxification is always the first step. It is not a treatment.”

Rapid detox is a controversial method of putting a patient under anesthesia and administering an opioid antagonist to block heroin from reaching receptors in the brain. Withdrawal is accelerated and the patient sleeps through most of the withdrawal symptoms.

Collins said, “On one side, it’s very humane. On the other side, you’re not going through the hell that you might need to go through to never do this again.”

Behavioral therapy can be delivered in either inpatient or outpatient settings. Collins said residential treatment can be even more effective, especially for patients with co-occurring disorders.

However, he said it is difficult to find a facility willing to take a patient with a dual diagnosis of drug addiction and another mental health issue. Citing barriers to treatment, he said, “We need more centers. We barely have any.”