How the heroin crisis exploded around Boston

By Meredith Enright, N.P.
Hallmark Health Medical Associates

Meredith Enright, N.P.

The other day I found myself talking to my nieces and nephews about heroin and pain pills. One is 10 years old, and the oldest is 12. Unfortunately, now is the time to have that conversation.

We are in the middle of a heroin crisis, especially here in the Boston area. We’re learning that lots of heroin addicts started by using opioids such as prescription pain pills. There were 1,620 unintentional overdoses due to opioids in Middlesex County between 2000 and 2014. The number of people dying this way has continued to climb through the years.

I brought the topic up to my nieces and nephews because of a patient who visited me one day. His journey to becoming a heroin addict started during high school when he was at a party. Other kids there were smoking marijuana, but that night he decided to try OxyContin (an opioid pain killer) for the first time.

“It’s a pill, and it was prescribed by a doctor – how harmful could it be?” he thought.

At the time, many healthcare professionals were prescribing opioids to chronic pain patients. Now we know the ugly truth about opioids – they lead to far greater problems than we ever thought possible.

What started as an addiction to OxyContin turned my patient into a full-blown heroin addict. I’ve seen many patients like him in my office throughout the years who realized they were sick and needed help to get clean.

It’s time that all of us in healthcare take responsibility for how this mess got started. We need to deal with the problem immediately and stop treating addicts like they are unworthy of the help they need.

Meredith Enright explains how powerful painkillers led to a heroin crisis.

Bad information led to a big problem

There’s no simple explanation about why the heroin crisis began, but many people, including myself, believe it began when we started using more powerful medications to treat chronic pain.

In the late 1990s and early 2000s, a movement began for healthcare providers to treat pain more aggressively. Many believed that pain was being undertreated.

Pain became the fifth vital sign. You’ll notice it now when you’re admitted to the hospital – nurses and doctors now ask, “How would you rate your pain today?” In 2001, the Joint Commission issued pain management standards so a patient’s pain level was more closely monitored and treated.

At that time, painkillers known collectively as opioids – oxycodone (OxyContin, Percocet), hydrocodone (Vicodin), morphine, and others – were usually reserved for short-term pain, cancer-related pain, or end-of-life treatments. With the new standards, doctors began prescribing opioids to patients with chronic pain.

Everyone was relying on two reports published by medical journals in the 1980s that deemed opioid painkillers safe to prescribe and non-habit forming. There was a very low risk, according to the reports. One short letter to the editor in the New England Journal of Medicine even falsely stated that “less than 1 percent” of patients who received narcotics while hospitalized became addicted.

That was bad, false information. We now know that opioids are extremely addictive and dangerous if they are not used as directed.

It got out of control. People became addicted. Addicts lied about pain to get their pills, and sometimes the pills wound up in the hands of kids. Lives were destroyed.

Even worse, many of these people turned to heroin when the prescription painkillers were no longer satisfying their addiction. It’s been estimated that four out of five heroin users started with opioids that were prescribed to them.

I’ve heard first-hand how these addictions can destroy families. Some of the parents who have been in my office have lost children to heroin. One told me about her daughter who was prostituting herself to get her fix. The stress these people are under can be debilitating.

Where we are today with the heroin crisis

Today we are dealing with a new kind of problem. For about a decade, opioids were the answer for chronic pain. But many of the pain clinics that prescribed them have closed their doors.

Their patients are now left to deal with addictions to OxyContin, methadone, and other opioids for which many physicians are hesitant to write prescriptions. Every day, 46 Americans die from prescription opioid overdoses. Some who are addicted are trying to get clean and are facing withdrawal. For some, the symptoms are so bad they can’t lead their lives.

We work with these patients to help them get off opioids. It usually starts with education – they don’t understand why they need to stop taking a prescription medication they’ve taken for 10 years. In their mind, it’s saved them a decade’s worth of pain. As care providers, we see it as a slippery slope to further complications, including addiction.

It may not be easy to determine whether you are addicted to opioids. These are common symptoms, but not all-inclusive:

• You think about your medication often – when you can take it again, when you can refill it, whether you have enough.
• You visit more than one care provider to try to get more of the same prescription.
• You’ve been taking painkillers for much longer than your care provider deemed necessary.
• You get medications in unsafe ways, like ordering them online, buying them on the street, or intentionally hurting yourself to get more.

If you experience any of these symptoms, make time to visit with your care provider.

There is hope, and there is help

There are three groups of people who need help. There are people with chronic pain. There are people who are addicted to opioids. And there are people who are addicted to heroin.

No matter what you or your loved ones are dealing with, I want you to know three things:

• We’re here to help.
• We won’t judge you.
• There is hope.

If you have an addiction, you don’t have to be embarrassed. But you do need help. We’ve helped many heroin addicts get clean, and lots of them have made full recoveries. They’re leading normal lives now.

If you are addicted to opioids, we can help. We’ve weaned people off OxyContin, Vicodin, Klonopin, and Valium. Sometimes the process takes a year or more. There are many local addiction recovery services available.

If your pain persists after you’re off opioids, we have several treatments that can help. Depending on what kind of pain you’re experiencing, there are often medications, therapies, and/or exercises that can help. We also have a pain medication psychologist who can talk with patients about the emotional impacts of chronic pain.

Remember, there is hope, and we are here to help.

Do you suffer from any of the issues listed in the story? Contact us to learn more, or schedule an appointment with Meredith Enright directly.