Chasing the euphoric warmth of a heroin high leads down a dark path.
Consider this: Paramedics from LifeCare Ambulance — which serves half the population of Lorain County — rushed to 1,028 overdose calls between Feb. 20, 2015, and the same date in 2017, a huge portion due to heroin.
But why is the pull of opioid drugs so strong?
To learn more about what heroin and its close cousins do to the body, we sat down with Jim Thoburn.
With 15 years of experience as a paramedic and a master’s degree as a physician’s assistant, today he serves as the assistant medical director for the emergency department at University Hospitals Elyria Medical Center.
INSIDE THE BODY
“Opioids are designed to relieve pain. For someone who isn’t predisposed to addiction… if they, say, have a broken arm and taken an opioid for relief, they no longer have pain,” Thoburn said, explaining how hospitals use drugs like Percocet, Oxycodone, and Vicodin. “That’s it. The pain is relieved and they no longer have need for the opioid. That’s why this stuff was invented.”
In small, controlled doses under a doctor’s direction, painkillers are helpful. They bind to receptors in the brain that cause your body to release dopamine and other natural chemicals that dull pain.
Thoburn said problems arise when people take legal drugs too much or too often, use painkillers for the wrong purposes, or when they buy street drugs far more potent than what doctors prescribe.
“Having talked to addicts for years, when I have a chance to sit down with them and ask about their first experience, I learn that first exposure to an opiate is an exposure unlike anything they’ve had before in their lives,” he said.
Heroin doesn’t cause visual or auditory hallucination like LSD. Instead, users feel energized, worry-free.
One addict told Thoburn his first hit made him feel like “the president of everything. They feel they are in control.”
One hitch: The first blast of euphoria won’t ever come back. Each use has diminishing returns and addicts have to use more and more to get close to the same high.
Many heroin addicts need to feed their habit three times a day, Thoburn said.
He estimates 40 percent of all Elyria ER patients are dealing with addiction, even if it’s not the reason for their visit. Most overdose victims are treated and walk out under their own power within two hours.
Sometimes they’re back the same day after finding another dose of heroin, he said.
Doctors, like paramedics, have noted the disturbing uptick in overdose patients the past few years. It’s gotten so bad that when they hear a patient is “unresponsive,” they don’t think of a heart attack or stroke — they immediately brace for an overdose.
Heroin acts as a depressant for the central nervous system, specifically the part that automatically controls breathing.
We’ve read scores of police reports and heard many EMT accounts of unconscious patients, barely breathing, lips and fingernails blue, skin pallid, heart rate slowing as the brain and heart slowly suffer from hypoxia.
That means the heroin has stopped their breathing, which halts the flow of oxygen through the body. The victim slowly dies of oxygen starvation over the course of five to 10 minutes.
If they can be quickly revived, the body is remarkably resilient. Most organs heal.
The brain has a harder time recovering. Thoburn said nursing homes are filling up with 40-year-old addicts whose mental abilities have been severely diminished by opioid abuse and they can no longer care for themselves.
Chronic use of opioids also causes emotional and social withdrawal. Addicts will distance themselves from family, jobs, and hobbies. They will become fixated with only themselves.
“They become absent parents. They become disinterested employees,” Thoburn said.
Doctors embraced Oxycodone when it hit the market in 1996.
Of the prescription meds out there, it’s the closest in chemical composition to heroin. It’s supposed to be a long-acting, extended-release pill, but addicts quickly discovered they could get a huge rush by crushing and snorting or injecting it all at once.
Thoburn said that’s why Oxycodone has the highest illicit demand today and the greatest street value. Close behind are cousins such as Percocet and Vicodin.
No one meant to over-prescribe, he said. In 2001, the medical community labeled pain the “fifth vital sign” and doctors nationwide were told they were actually under-prescribing.
So they started giving patients larger and larger bottles of pills to help manage pain.
“We have turned a corner on that and realize we made a huge mistake,” Thoburn said. Now doctors are much more conservative with opiate prescriptions, opting for alternatives such as physical therapy, non-opioid painkillers, exercise, yoga, and even acupuncture.
For many, that’s been a blessing, he said. But for those already addicted to doctor-prescribed pills, it’s often meant turning to the black market for the next high, and ultimately to straight heroin.
What can be bought illegally is uncontrolled, said Thoburn. Unlike carefully measured medications from a doctor or pharmacist, street heroin varies by batch. There’s no way for an addict to know ahead of time how potent it is or whether it’s been mixed with other drugs such as fentanyl.
A PLEA TO KIDS
Thoburn is passionate about the opioid problem Lorain County is facing, which he sees affecting — and killing — many, many patients.
That’s why he is part of a task force organized by Ohio Attorney General Mike DeWine to fight heroin abuse.
The group’s goal is to stop children from trying heroin the very first time.
“This is one experiment that will kill you,” Thoburn said. “We realize you’re a kid. You’re going to experiment. That’s just what kids do. It’s a natural part of adolescent development. But don’t do this.”
He said he’d much rather see rebellious teens drink beer or dabble in cigarettes than inject heroin.
Jason Hawk can be reached at 440-988-2801 or @EditorHawk on Twitter.