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Heroin: Myths and Misunderstandings

Heroin use is full of misunderstandings and myths. Some of the false assumptions that persist are:

  • Myth: Heroin use is a young person’s problem: “The myth that heroin is a young person’s problem is based on the belief that people ‘mature out’ of use by their late 20s. This is belied by the fact that a third of heroin users are over age 40. In fact, the average age at death from overdose is in the late 30s, and fewer than 5% of cases are teenagers. What’s more, we’re now seeing overdose fatalities aged in their 50s and 60s. Australian research from 2013 found overdose deaths among 35- to 44-year-olds had risen sharply in the past few years, as had deaths among 45- to 54-year-olds.” (Darke & Farrell, 2014, cited in Live Science's Expert Voices: Op-Ed & Insights)
    “The most common trajectory is for heroin use to commence in the late teens, and to persist through cycles of treatment and relapse for decades. Some give up early, but they represent less than a tenth of those who take up the drug.” (Darke & Farrell, 2014, cited in Live Science's Expert Voices: Op-Ed & Insights)
  • Myth: There are a large number of highly functioning “recreational users” of heroin. “The myth regarding a large, hidden group of highly functional users has no evidence at all to support it. The evidence from treatment, from fatalities and from epidemiological studies is clear. The typical picture of an active heroin user is a dependent, long-term unemployed person, with a long history of treatment and relapse, and a history of imprisonment. Heroin is simply not the sort of drug that could be termed ‘recreational’ because very few people use it in a non-dependent, non-compulsive fashion. If recreational users exist, they are a rare phenomenon.” (Darke & Farrell, 2014, cited in Live Science's Expert Voices: Op-Ed & Insights)
  • Myth: Overdose deaths are due to variations in drug purity: “The purity myth is perhaps the most persistent of all, even though the epidemiological evidence shows quite clearly that variations in purity are only modestly related to the number of deaths. Deaths are concentrated among long-term users with high opioid tolerance. What’s more, in a large proportion of fatal cases, the concentration of morphine (the major metabolite of heroin) is low. Indeed, the impurity myth, that overdose deaths are not due to heroin but to toxic impurities, has absolutely no evidence at all to support it….” (Darke & Farrell, 2014, cited in Live Science's Expert Voices: Op-Ed & Insights)
  • Myth: With opioid overdoses, death occurs instantly. Research indicates that death usually takes one to three hours after injecting heroin (Seal et al., 2003). In addition, most overdoses are witnessed by peers (Darke & Zador, 1996). In overdoses, there is a window of opportunity for medical intervention.
  • Fact:  Use of multiple drugs along with heroin can be fatal. "What does kill heroin users is polydrug use. More specifically, the use of heroin with other central nervous system depressants, such as alcohol and the benzodiazepines. Death is due to respiratory depression, from the combined effects of these substances. While one of these may not kill if taken alone, together they are toxic. That’s why we see a large number of deaths with low morphine concentrations.” (Darke & Farrell, 2014, cited in Live Science's Expert Voices: Op-Ed & Insights)

References

Darke, S., Farrell, M (2014). Expert Voices: Op-Ed & Insights. Live Science. February 2014
http://www.livescience.com/43238-three-persistent-myths-about-heroin-use-and-overdose-deaths.html
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Darke, S., & Zador, D. Fatal heroin “overdose”: a review. Addiction, 1996, 91, 1765-1772.

Seal, K.H., Singleton-Banks, S., Hannon, J., Lorvick, J., Ciccarone, D., & Edlin, B.R. (2003). Attitudes about prescribing take-home Naloxone to injection drug users for the management of heroin overdose: a survey of street-recruited injectors in the San Francisco Bay Area. Journal of Urban Health, 80, 2, pp 291-301.