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Opiate Addiction in the Suburbs

I once got into serious trouble, while at a meeting in a very politically correct setting, when I made a candid unrehearsed comment “Maybe heroin will help us solve the race problem in America.” This was many years ago before the resent very public acknowledgment of the magnitude of it opiate crisis in America. At this meeting, the discussion was about drug abuse in the inner city. The people who are raising funds for this inner city program were complaining that they were primarily set up alcohol and crack cocaine related drug abuse. They indicated that they needed more funding because “all these people were coming in from the suburbs addicted to heroin.” The truth is heroin and for that matter all the opiates and opioids do not discriminate based on race socioeconomic status, gender occupation or any other social or human criteria. It is also very true that opiate dependency SEEMS to disproportionately affect suburban white patients. But in my opinion, this is only because they find ways to be able to afford $100 to $300 per day habits. The 95% or more preponderance of white patients and opiate treatment centers more reflects other socioeconomic disparities in our society rather than anything else to do with race per se. The occasional African American patient with opiate addiction presents with the exact same ugly symptoms of withdrawal. They cheat their family and friends and do illegal things to get their fix the same way as white patients. They just don’t usually get away with it as long before being forced to either get help or suffer the consequences of withdrawal. They are less likely to have a job that will allow them to be able to afford their habit. They are less likely to own their own business all work for their families business. Thus, they will lose their jobs more quickly. They also will be more willing to seek help in places like indigent clinics where suburban kids would not be caught dead. (no pun intended)

The following is paraphrased and edited from a Mayo clinic publication brought to my attention recently.

Addiction has the same effects on a person no matter who they are. The signs of addiction are the same, regardless of a person’s background, status or gender. clear signs that an addiction is present:

Needing drugs or alcohol in order to function in everyday life

Stealing to get money to pay for drugs

Drinking or using pills or injecting or snorting several times throughout the day

Being unable to stop using even when the desire to stop is there

Most drug addictions start with experimental use of a drug in social situations. In my opinion- Marijuana is a gateway drug.The earliest exposure to other drugs occurs in the same setting as the common marijuana use. After initial experimentation, for some people, the drug use becomes more frequent. The risk of addiction and how fast you become dependent varies by drug. Some drugs have a higher risk and cause dependency more quickly than others.

Over time, you may need larger doses of the drug to get high. This is known as tolerance. Soon you may need the drug just to feel good. I prefer to describe this as eventually people have to use a drug to keep from being sick.. Attempts to stop drug use may cause intense cravings and make you feel physically ill (withdrawal symptoms).

A most reliable but subtle indication of addiction is the observation that a patient makes certain that you maintain a supply of the drug. They will keep stashes I never run out. A few more obvious clues are: spending money on the drug, even though you can't afford it

not meeting family obligations and work responsibilities, or cutting back on social or recreational activities because of drug use

No one disputes that addiction is present when a person starts doing things to get the drug that you normally wouldn't do, such as stealing or swapping sex for money or drugs.

Driving or doing other risky activities when you're under the influence of the drug

It may seem a bit cynical of me to say this, but observing these addictive behaviors in the suburbs and unfortunately witnessing deaths of suburban kids has been good for the overall development of treatment programs for everyone. For almost 40 years an emergency room settings, private practice and many other settings I have dealt with the wrath of drug abuse. None of the recent attention should be newsworthy. I treated my first drug overdose patient in 1979. Nevertheless, I welcome the public attention that has been given to this problem in recent years.

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