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North Hills Monthly

What is Being Done to Combat Heroin Abuse in Our Area?

Jan 29, 2016 05:22PM ● By Hilary Daninhirsch
Dr. Neil Capretto
Heroin abuse is an epidemic in our area: we have one of the highest heroin overdose rates in the country, and the numbers are rising annually. It is an addiction that has its roots in overprescribed opiate-based pain medication and affects people across all socioeconomic groups.

We spoke with Dr. Neil Capretto, medical director at Gateway Rehab. In addition to overseeing the treatment of patients, he also works with staff and community groups to educate the public about the dangers of heroin.

North Hills Monthly (NHM): What exactly is heroin, and why are we seeing such a rise in its use?
Dr. Neil Capretto: Heroin is an opioid that has very similar effects on the brain as morphine, and drugs like Oxycontin and Vicodin. The big thing that fueled its growth was the prescription drug problem. How does heroin, a drug of the inner city, now make its way to Cranberry, to Saxonburg, to Beaver, to Mt. Lebanon, to Fox Chapel? Because of prescription pills.

NHM: Why the change from pills to heroin?
Dr. Capretto: There was a big emphasis in the medical profession in the 1990s to better treat pain, and a lot of the medical profession was misled about the non-addictive properties of Oxycontin, etc. The dramatic availability of opioid pain pills led to thousands getting addicted, and they quickly found it was expensive to keep using pills; so it was the perfect storm—instead of $200 a day on pills, you can spend $40 on heroin, and all you have to do is sniff or snort it. Thousands of people switched to heroin. Of the last 5,000 new heroin users that I’ve treated, at least 95 started with prescription pills first.

NHM: Is it more of a problem here in western Pennsylvania than elsewhere?
Dr. Capretto: Southwestern Pennsylvania has a disproportionate rate than in the rest of the state; rates of heroin overdose have dramatically gone up. This has been building up for 15 years, and we’ve really reached a peak now. We are still somewhat higher than the rest of the country and that is because of our demographics; we are an older population and people have medical issues that could legitimately require pain medications. Between heavy marketing by pharma companies and the need for doctors to prescribe medications, it helped some people, but the bad news is it got diverted onto the street and got into the wrong hands. It was happening when our economy was depressed; pills became a commodity in an underground economy.

NHM: How easily accessible and affordable is heroin?
Dr. Capretto: People who are involved with heroin can get as much as they want, usually within a few minutes, as long as they have the money to do so. My patients say, ‘Drop me in any community in western PA, and I guarantee I can find it in 15 to 30 minutes.’ And the price has gone down. When I was first hearing about heroin coming in 1995 or ‘96, a bag was $15 to $20 in the city; in the suburbs, up to $35. Now you can buy 10 bags for $60-70.

NHM: Is there a ‘typical’ heroin user?
Dr. Capretto: The biggest group is ages 18 to 25, but I’ve treated many 14- and 16- year-olds who have been using for two to three years. One of the highest overdose rates is in the ages between 50 and 60. On average, heroin users tend to be less educated, but years ago, there was a much greater discrepancy. Many people with masters’ degrees, Ph.D.s and MDs have significant opioid problems. Of all new users, by far they are disproportionately Caucasian; however, they are from all walks of life. This does not discriminate.

NHM: Does today’s heroin have the same chemical make-up as the heroin from several decades ago?
Dr. Capretto: It tends to be stronger. The heroin that was out through the Woodstock-era averaged around 10 percent purity. Now most heroin is over 40 percent pure—and there are batches that are 70 to 90 percent pure. A new and alarming trend is that people are adding a drug called Fentanyl to heroin. It is another opioid but even more powerful—it is 70 to 100 times stronger than morphine. A bag with that can be stronger than 10 bags of regular heroin, which is already pretty strong. Unfortunately, this leads to more overdose deaths.

NHM: Why the change in strength?
Dr. Capretto: One reason that they made it stronger is that heroin use went down in the 1980s when HIV became part of our awareness and people were afraid of needles. Then crack cocaine made it possible to smoke and inhale drugs. Dealers wanted to figure out a way that people could initially use heroin without using a needle. Ninety-nine percent of heroin users I see started off snorting or sniffing it, but within four to six months, the vast majority of users switch over to a needle as they develop a tolerance, because a needle works faster. That has led to a variety of problems, including a dramatic rise in Hepatitis C and increased rates in HIV because of needle use.

NHM: What is being done to combat this problem?
Dr. Capretto: If there were one simple solution, we’d be doing it, but it requires multiple efforts from multiple parts of our community. I co-chaired a western Pennsylvania task force on addiction that focused on prescription drugs and heroin, and we created a booklet with two dozen recommendations and community education information. We are educating families about being more aware and about prevention, and we are working with schools. We are trying to educate physicians about knowing what addiction is and the addictive potential of the meds that they prescribe—to be more careful and mindful and to look for alternatives. For example, if someone needs three days of a medication, don’t prescribe it for 60 days. And the DEA (Drug Enforcement Administration) will have more emphasis on going after drug traffickers and treating addiction like a public health issue; both the DEA and FBI recognize that we cannot incarcerate our way out of this problem.