The Doctor Is In

Q: I was shocked that Philip Seymour Hoffman died of a possible heroin overdose and that heroin is becoming a “popular” drug even in affluent  areas like the Palisades. Is it really a problem here and what can parents do about it?

A: Unfortunately, heroin is not just a drug you find in junkies on skid row anymore, as we all have seen with the overdoses of popular celebrities like Cory Monteith and now Philip Seymour Hoffman. This is a growing epidemic in middle class and affluent suburbs like Pacific Palisades. As both an internal medicine physician and an addiction specialist in town, I am seeing more teens and young adults come to my office asking for help with their heroin addiction. Also, as medical director of Cliffside Malibu Treatment Center, I am admitting more young people from all over the country  into rehab because of heroin.

Why the uptick in heroin? For one, young adults are starting with presciption pain pills like Vicodin, Percocet, and Oxycontin. They get these from their parents, medicine cabinets, friends or from overly prescribing doctors. Then, the pills become too expensive, and they turn to heroin because it is a lot cheaper and surpsingly a lot more available. While one Oxycontin pill can cost up to 30 dollars on the street, one hit of heroin can be bought for only six to ten dollars a bag. In addition, the pharmaceutical companies have started to make the pain pills more tamper resistant so that they are difficult to crush and snort for a better high, and doctors have more access to databases to find patients who are “doctor shopping” for multiple prescriptions. One 17-year-old addict I met last week told me heroin was easier to get than beer.

About 25 percent of people who try heoin become addicted, and I have seen first hand how destructive this drug can be for the addict as well as the families involved. These young kids with promising futures who come from good families are throwing away everything just to look for their next high. The most concerning part is how deadly this particular addiction can be.

Although Hoffman was an exception, I don’t see too many heroin addicts beyond the age of forty due to the high mortality of this drug. In 2010, heroin overdoses killed more than 3000 people across the United States, a 45 percent increase since 2006, according to the Drug Enforcement Agency.

So what can parents do? The good news is that help is widely available. First, I stongly urge all parents to talk to their pre-teens early on about the dangers of drugs and alcohol–not just  a one-time educational lecture, but an ongoing check-in with their kids about what’s going on in their school and knowing their peer group. Talk to other parents, and know where and with whom your kids are spending time. Look for signs of trouble like changes in sleep patterns, new groups of friends and a sudden drop in grades or lack of interest in activities that the child used to find enjoyable. Then, seek professional help with any concerns with a general doctor, therapist, psychiatrist or addiction specialist. Home drug tests can also be helpful.

Once a problem with addiction is confirmed, the best thing to do is to put the addict in a comprehensive inpatient rehabilitation program. This involves first detoxification, which most heroin addicts are scared to death about. This is because when they have tried it on their own, detoxing can be extremely uncomfortable with symtoms such as “skin crawling,” severe muscle pains, vomiting, diarrhea and insomnia.

Under a doctor’s supervision with the latest medications, this process can now be very comfortable. After five to seven days, the addict can now embark on the therapeutic process to really start repairing the psychological trauma that may have led them to become addicts in the first place. This often takes 60 to 90 days or longer. There are also medications that can can help the heroin addict prevent relapse by blocking the opiate receptors in the brain.

As we saw with Philip Seymour Hoffman, addicts are still vulnerable even years after quitting drugs if the right stressors or triggers come along. For those who can’t or won’t go to an inpatient rehab center, there is still help available by finding a physician who understands addiction, and by getting a good therapist and attending AA or NA meetings.

These celebrity deaths from heroin overdoses should be a wake- up call to this community. Heroin really is among us, where you might least expect it. If anything good comes from these deaths, it would be that we as a community keep our eyes open and help those loved ones before it is too late.