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Heroin Holding More and More People Under Its Spell

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Backes put the numbers in perspective by comparing them to alcohol-related auto fatalities in the U.S. "There's 16,000 a year alcohol-related auto fatalities, so comparatively, we're talking about a huge public health problem related to drugs that's not being addressed. So if it rounds up to maybe 10,000 in the U.S., we're talking comparatively, a massive problem of which there's been very little attention [paid]."

Of course, it just makes sense that if that many people are overdosing, many more are using the drug who aren't. Oxman says it's estimated there are about 10,000 active heroin users in the community around Portland. Backes says a "standing estimate" for injection drug use in New York state over the last 10 years has run up to 250,000 and there's large injecting populations in Baltimore, Philadelphia, Newark, and Boston, to name a few.

And these people come from all walks of life; they're not all street urchins and criminals. "There's the popular image of the heroin user as being very down and out, a homeless criminal type ... what we're talking about is people who use heroin and represent a very wide cross section of the community. These folks are not monsters, they're human beings and they're struggling with a horrible addiction that they can't drop," Oxman says.

No longer is it necessary to be a full-time criminal to afford heroin, although many users can obviously fall into crime as their habit progresses. Many people work minimum wage jobs and maintain a heroin habit, Oxman says.

The drug dealers in Portland, for instance, have a very sophisticated distribution network that reacts to change very quickly, according to Oxman. The heroin is easily found, and usually is sold in a "balloon" or packet, consisting of one-eighth of a gram, for $20.

That is not the only reason for all the overdoses, though, Oxman says. In local interviews of heroin users, he says many long-term, 15- to 20-year users admitted to having lived through two to six overdoses.

So "they don't believe they're at a huge risk for overdose. Indeed, their experience suggests that," Oxman tells WebMD.

What finally gets the addicts is a mix of factors. The black tar is "fairly potent stuff," but has a tremendous variability. Oxman says "it's always a guessing game as to how strong it's going to be." For some people who don't "test" the dose, the drug may prove lethally potent.

Another problem is sometimes people try to kick the habit, or perhaps get thrown in jail for a week. During that time, their tolerance level changes, but they shoot the same amount of heroin as they used to, causing an overdose.

It typically takes a person one to three hours to die from an overdose after their most recent shot. The majority of the deaths are witnessed, according to Backes, and most of the other witnesses are drug users. They may have an outstanding warrant, or they might just fear arrest. They might simply not want to get locked up in a drug-free jail. The causes of overdose are many.

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