Heroin Addiction Pt. 1, Las Vegas Sun

Escaping heroin’s iron grip Lisa Sciortino Saturday, Aug. 17, 1996 | 11:59 a.m. First of two parts in the Las Vegas SUN. He craved relief from the constant, throbbing pain in his slowly mending bones. Except for his neck and pelvis, all his bones had been broken at one time or another and he'd spent two years in a body cast: The price you pay for living the daredevil life of a professional motocross racer. "When I came out," says "John," his voice groggy and gravelly, "the doctors had me on some kind of pain medication and then they just cut me off cold turkey." Then, not long after graduating from college and moving to Las Vegas from the East Coast, he was hit by a drunken driver and developed a seizure disorder. Again, doctors prescribed a collection of brown bottles -- Percocet, Percodan, Demerol -- to alleviate John's aches. They became his lifeblood, the synthetic strength he required to rise in the morning and continue on through the day. He was hooked. And again they cut off his supply. This time, though, he knew where to turn for help -- no prescription needed. "I got hooked up with some people from back East that I met and I started using heroin." It nearly killed him. "In the mornings, I didn't even want to get out of bed," recalls the 34-year-old, looking scruffy in a stained Joe Camel T-shirt and jeans. "I'd buy a bag of heroin at night and cook it up (with water). I wouldn't even put it in my vein, I'd just stick it in my muscle, just to get out of bed. "I've shot it everywhere except for my penis. I've tried to do like the dentist and find the vein that they use (to administer anesthetics), but it didn't work." Heroin, he says, "makes you feel like a million dollars when you do it. I had no pain, no aches in my body whatsoever. It just makes me feel like a new person." After years of poking and puncturing, the veins on his forearms are all but invisible. "Look, I've got nowhere to shoot up. The only veins I have left, that I can find, are in my neck." Jabbing the needle into his jugular hurts the worst, though. At the peak of his addiction, John was shooting, smoking or snorting $300 worth of the powdery stuff every day. In the meantime, his marriage fell apart, and his auto body repair business was squandered to support his habit. Now, 10 years, several near-overdoses and three failed detoxes (two at home, one in jail) later, John's trying to kick his addiction once and for all. He recently checked himself into St. Rose Dominican Hospital's detoxification program. He's hoping the fourth time's the charm. "I'm not gonna use no more. I'm positive this time." That remains to be seen. But one thing is certain: John won't experience detox alone. He'll have plenty of company, thanks to the recent resurgence in heroin's popularity and return to the trendy status it enjoyed during the '60s and '70s. It's purer and more potent than it was then. Cheaper, too. A bag of black tar, Red Rum (murder spelled backward) or Mexican brown heroin (containing about a thumbnail-size amount of the drug) can cost as little as $10 and produce a day-long high. Just like the Janis Joplins and John Belushis of yesteryear, '90s heroin has attracted a deadly celebrity following. In recent months, it's claimed the life of Jonathan Melvoin, 34, backup keyboard player for the Smashing Pumpkins. The band's drummer, Jimmy Chamberlin, 32, was arrested on charges of heroin possession. Actor Robert Downey Jr. ("Less Than Zero," "Chaplin") and Scott Weiland, frontman for the rock band Stone Temple Pilots, are in rehab in Southern California for heroin abuse. David Gahan, singer for the '80s pop band Depeche Mode, was recently busted for drug possession following a heroin overdose. It also hit the big screen in the recently released British film "Trainspotting." The low-budget flick takes a gritty, pitiless look at the life and times of four young, Scottish heroin addicts. The drug has even made its mark on the fashion world. Sickeningly skinny, sullen-faced supermodels are being featured in fashion photo spreads -- sleeves rolled up, arms outstretched, they walk zombie-like down runways in a look dubbed "Junkie Chic." So far, it seems Las Vegas has managed to buck the heroin trend, said Metro Police narcotics bureau Capt. Charlie Davidaitis. "I think it's safe to say that heroin in our community is not the drug of choice," he said, noting instead the popularity of methamphetamine, which accounts for more than 60 percent of drug investigations and arrests here. In fact, Nevada accounted for 15 percent of all methamphetamine interdictions that occurred from April 1995 to April 1996 on highways, at airports, bus and train stations in an eight-state region in the West. Meanwhile, only one kilogram of heroin was seized in busts throughout the eight-state region. "We see that the number of heroin addicts is much higher in Eastern, urban areas" such as Baltimore and Philadelphia, Davidaitis said. "I don't know why (Las Vegas has) not had the proportion of heroin addicts that others cities have. I would have to say that the lifestyle here is fast and furious" and methamphetamines "are more in keeping with that lifestyle." Though heroin seizures here are up from last year, the increase is only slight, Davidaitis says, pointing to a recent case in which 5 ounces of Mexican brown heroin were confiscated. "It's here and I believe we're gonna see a lot more of it." And more junkies. But what happens when the high wears off? Or when the law finally catches up with a heroin user? For most, it means a trip to the detox center. Despite the messages that fashion ads are portraying, recovering addicts like John and the physicians who treat them say the agonizing withdrawal symptoms that characterize heroin detoxification are anything but glamorous. A week's worth of vomiting, itchy skin, extreme anxiety, crippling muscle cramps, insomnia, loss of appetite. "Hell" is how Dr. Ervin Maveal describes it. And he would know. Maveal is director and admitting physician of the outpatient chemical dependency services program at Montevista Hospital, and former medical director of the Nevada Treatment Center. He is also a recovering addict. The doctor was hooked on narcotics for about 10 years, and spent a year in a psychiatric hospital during the '70s before entering rehab and getting his life back on track. He moved his practice from the Midwest to Las Vegas in 1979 and stayed clean and sober for nine years. Then he relapsed "big time." Luckily, Maveal's second trip to rehab was his last. He cleaned up his act, became a member of the Society of Addiction Medicine and still attends self-help meetings five or six times a week. "This is why I don't feel that I'm a threat for relapse at this point," he explains. But the experiences have helped him understand exactly what his detox patients endure. "I ... experienced all the wreckage that can happen to someone. I'll tell you, it breaks my heart to see some people come through it." The few that he does see, that is. Maveal guesses he's treated only a handful of heroin addicts through Montevista's outpatient program in the last six months. "We don't even expect them to show up at the hospital," he says. "It's very difficult to get them to detox for a number of reasons," mainly financial. Hospital stays can cost up to $1,000 a day and last anywhere from a week to 21 days. The trick is getting patients to stay. Because the opiates found in heroin latch on to receptor sites in the brain, the addiction is not only a physical one, but mental. It can be five to seven days before a person's system is completely opiate-free. Withdrawal is punctuated by bouts of diarrhea, agitation, sweats, seizures and severe mental anguish that can include psychosis. "You've taken this artificial support system away from their nervous system and now you have someone who's craving something to make them feel better," Maveal says. "He's got the physical craving as well as the psychological craving. It's the next thing to a nightmare." Dr. Mel Pohl, medical services director of the addictive disease program at Charter Behavioral Health System of Nevada, says heroin withdrawal "physically is probably the most uncomfortable withdrawal people go through. It's an intense pain. "Opiates are pain relievers," he explains, "so when you stop opiates, you have pain. These are people who don't like pain. That's one of the reasons they get hooked on these drugs. So their pain threshold ... is very low." To help subdue the symptoms, addicts enrolled in inpatient detox programs are often administered a variety of drugs: muscle relaxants, anti-anxiety agents like Valium, nonaddicting tranquilizers, even Clonidine, a blood pressure medicine that happens to cross-react with the same receptor sites the opiates inhabit. "We try to use a medication that's different than the one they were using, but is enough like the one they were using so they don't have a severe withdrawal," Pohl says. "Then we gradually decrease their dose. That's the principle of detox." But masking the pain only works for so long. "You can never give them enough medication to make them feel good," Pohl says. "They just have to live through some of the discomfort to get to the other side." The first few days of detox pose the greatest hurdle for patients. A good many of them don't make it through. During his fourth day of treatment at St. Rose, John recalls how he nearly walked out of the hospital earlier in the week. "I wanted to get well. I was sick," he says, meaning that he needed a fix. "The back of your legs hurt to where you can barely walk. It always seems to strike me there." And temptation loomed large. "If I wanted to go and get high again right now, I've got $1,000 waiting for me. I was real scared about today because of that." Maveal wishes some of his patients had that kind of willpower. "They've got to want to be there in the first place," he says. "The ego gets in the way. The main thing is they don't believe it's a disease." An alternative to the ravages of detox is drug replacement therapy using methodone, a narcotic that is no less addicting and reacts the same way as heroin on the brain and body. Thus, there's no need for patients to detox before beginning methodone treatments. Administered in daily doses by physicians, the drug is often prescribed to patients for indefinite periods. "It basically means trading one opiate for another," Pohl explains. "The difference is there's no needles involved and it's administered to the patients in a controlled environment so that they're not out on the street scoring drugs, risking getting infections and dealing with the kinds of people you deal with on the street." That's why methodone treatments have proved successful with many heroin addicts. "People go to work, they don't go to jail. They're not involved in illicit activities. They carry on successful families." "With the advent of AIDS, I would say the treatment field has come a long way. "Methodone used to be sort of the enemy. If we can prevent HIV infection from being transmitted (through needle sharing), then we've got to do whatever we can to do that, and methodone is one way." But, Maveal stresses, it's not for everyone. He oversaw methodone treatments at Nevada Treatment Center, one of four local state-accredited methodone centers. The best candidates are those who have been on narcotics for more than a year, shooting up at least three times a day. Once they're approved for the treatment, patients must be monitored regularly -- via urine analysis -- "to make sure they're not into other drugs." Once they're on methodone, however, it's tough to wean them off, as the physical withdrawal is longer and more intense than that of heroin. The best way to do it, Maveal says, is through a "very, very slow detox" of decreasing doses. "We'll watch them coming down ... and then they'll become regular citizens without methodone or other drugs." The actual flushing of opiates from the system, though, is only a small part of the detox process. Once that grueling portion is complete, it's time for an addict to begin picking up the pieces of his shattered life. "Now you've got someone that doesn't have a drug problem anymore, but now they have a major living problem," Maveal says. "They have all of these things that were blocking the receptor sites in the brain. You can't put the wiring back together just like that." The only way to do that, physicians contend, is through long-term after-care -- years of 12-step meetings, individual and group counseling sessions. "What treatment is all about is offering, on many different fronts, resources to help them survive in a world without drugs," Pohl says. Meetings are conducted in-house at Charter. "There are people that have trouble with some of the principles of recovery. We try to work with them on an individual basis. "We teach them about relationships, we teach them about communication, assertiveness. We teach them about family dynamics ... because there's often a lot of dysfunction. Lots of people don't have jobs or social skills or just haven't been functioning in the world." Also, 12-step programs allow them the chance to relate their experiences with other addicts on the road to recovery. Margret Piasecki, executive director of Nevada Treatment Center, says peer interaction helps break down the "stigma and shame" addicts often face. "As a society, as a culture, we nurture this mentality about immediate gratification and (the idea that) if you've got a problem, you can get rid of it by taking a pill," she says. "The other side of the coin is ... it's a lifestyle that needs to be changed. "Recovery is lifelong. It's comparable to dealing with cancer. You don't really cure it, you arrest it." And relapse remains a constant threat. "The drive for the drug is stronger than the recollection of the negatives," Pohl says. "An addict's view of escape is right through a tunnel. All they can see is 'I want to feel better now.' The people who relapse are the people that have a craving and use." John doesn't want to be one of those people again. Even before completing detox, he was planning his drug-free future with the help of a personal journal the hospital provided. "I've been writing notes in here -- what I'm gonna do if I start using again or whatever," he says. "I know if I ever run into any of my doper friends, I'm gonna run." After all, there's a lot riding on his sobriety. "My family is gonna accept me back," he says. "My wife is gonna let me come back home. "I have made a strong agreement with them ... and if I can't handle it, I'll be right back in here. But I think I can handle it."