September 5, 2016 • 60 mins
Cristen and Caroline trace why heroin is more popular among suburban, white women than ever before.
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Episode Transcript
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Speaker 1 (00:03):
Welcome to Stuff Mom Never told You from how stup
works dot com. Hello, and welcome to the podcast. I'm
Kristen and I'm Caroline. And a quick word of caution
before we get going that this episode is going to
talk a lot about hard drug use, specifically heroin use,
(00:26):
abuse and recovery. So if that is a topic that
you would prefer to avoid listening to for whatever reason,
totally fine. You have been warned. And let's get into
this really serious issue that has just skyrocketed in recent years. Yeah,
heroin use has really taken off in the US for
(00:48):
a lot of sort of uh intermingling reasons, um, And
it has really taken off too, among women in this country,
and so we thought it was time. As almost depressing
and sad as this topic can be, we thought that
it was really important to address it because we want
to better understand and we want you to better understand
(01:11):
what is behind more women abusing heroin and it's specifically
white women. And it's something too that's been in the
news so much. Um. President Obama really launched an anti
heroin initiative some months back, and I remember hearing, you know,
(01:31):
all of these press conferences about it and um, a
lot of politicians talking about it, both on the national
scale and also on the state level. And at the time,
I was a little mystified, thinking heroin, why, Okay, what,
what's behind this? What's going on back we're having a
nineties revival? Yeah, I mean, it just seems like such
(01:52):
an extreme drug. And this, really, you know, points my
ignorance about the issue because I did not understand and uh,
the very practical, unfortunately reason why there is a heroin
epidemic happening. Yeah, so let's hit you with some numbers. Basically,
heroin used in this country has increased across all demographics.
(02:14):
Three out of a thousand Americans said that they had
used heroin in which is the most recent year the
data is available, up from one in a thousand a
decade earlier. And while it remains highest among men, people
eighteen to twenty five, people who make less than twenty
k a year, people living in cities, and people who
(02:35):
are uninsured or on Medicaid, the greatest increases have been
seen among people who have historically had lower rates of use. Specifically,
it has doubled among women and more than doubled among
non Hispanic white people and This isn't just an issue
of people trying heroin once and then walking away. Um
(02:57):
as I think a lot of people know hair one
is extremely addictive. Nicotine is the only drug that we
know of it is more addictive in fact than heroin.
And heroin abuse and dependency jumped thirty five point seven
percent since two thousand eight to two thousand ten. And
about a quarter of people who try heroin just just
(03:19):
that once, perhaps thinking, will become dependent on it. And
that means we're having more overdoses and more death from overdoses. Yeah,
that's right. Uh. In two thousand two, Uh, there were
just over two thousand overdose deaths and that jumped to
more than ten thousand. And if you look at particular states,
(03:43):
you can see where heroin is just gripping towns, and
West Virginia in particular has been in the news this
past August and because the state has seen heroin overdose
deaths triple from two thousand nine to two thousand fourteen.
And on August fifteen, two thousand sixteen, twenty seven people
(04:09):
in this tiny West Virginia town called Huntington's overdosed one fatally,
all because of a bad batch of heroine that was
going around. Yeah, and if you look globally, opiate use
has been pretty stable at about seventeen million in fourteen,
but heroin trafficking has been on the rise. That's a
(04:31):
lot of that's a lot of kind of scary statistics,
a lot of scary numbers that more and more people
are using heroin. Um, but what is it? So let's
get into some DARE one oh one hashtag nineties nostalgia.
That's right, Does DARE still exist? DARE does still exist?
DARE stands for Drug Abuse Resistance Education? Yeah, and it
(04:55):
had you know that there was the red letters, big
DARE letters a black background that I remember seeing so
much around the same time when there were all those commercials,
the p s A s about this is your brain
egg is your brain on drugs? Cracked into the frying pan? Yeah,
And there was the commercial with the woman in the
tank top and she was like smashing up the kitchen. Yeah.
(05:18):
Was that also your brain on drugs? I think it was.
And that was also specifically heroin, I want to say,
which brings us full circle. Although that doesn't sound much
like heroin, which is a type of opioid derived from morphine.
And did you know caroline morphine is organic. It's a
naturally occurring substance extracted from the Asian opium poppies seed pod.
(05:44):
And whether it's organic or not. Uh, if you snort it,
injected or smoke it, heroin gets to your brain really fast,
meaning it is incredibly dangerous and incredibly addictive. So after
that first injection, for instance, users feel this rush of
euphoria and then they chase it after that first time.
(06:06):
But the thing is, it will never feel the same
after the first time that a person does heroin. What
happens is that it hits your brain and converts to morphine.
At that point, it then binds to your opioid receptors,
which are what deal with pain and reward perception. Uh.
And in your brain stem, those opioid receptors are involved
(06:28):
in just like really minor things like blood pressure and breathing,
you know. So what could possibly go wrong? Um? Well,
the thing is, when you're doing it over and over
in order to chase that high, chase that feeling of euphoria,
you build up a tolerance, so you need more and
more to avoid withdrawal symptoms. And those withdrawal symptoms include
(06:49):
things like restlessness, muscle and bone pain, UH, insomnia, diarrhea,
and vomiting. You might also get kicking movements and cold flashes.
But basically what's happening during this point is that your
brain's white matter is deteriorating and this is affecting your
decision making and your behavior regulation and stress responses. And
(07:11):
when you overdose, your breathing becomes suppressed because your brain
isn't getting enough oxygen, which can then lead to psychological
and neurological effects, including permanent brain damage. We cannot over
emphasize the heroin just is not good for you in
any dose. Heroin is not safe. No, please, please do
not do heroin because other side effects also include hepatitis
(07:34):
and HIV, especially since you do get the side effect
of lowered decision making and behavior regulating skills. So uh
if you're sharing needles or engaging in risky sexual behavior. Uh.
People who use heroin also might experience collapsed veins, infection
of the heartlining in valves, miscarriage, liver and kidney disease,
(07:57):
and gastro intestinal problems on top of all of that.
And that reminds me of something that CDC director Dr
Tom Frieden told The New York Times about how when
he was getting into medicine, the AIDS epidemic was happening,
and there was obviously like a lot of issues around
shared needle use with that, and how heartbroken he is
(08:17):
to see a similar issue happening all over again with
shared needles. Yeah, people out there who listen to NPR,
you might have heard the story. This was a couple
of months ago. Maybe there's a town in Indiana where
heroin use has exploded, and in a parallel fashion, so
(08:37):
his HIV. Because there's a lot of people in this
particular community and I can't remember what it is, but
where they are living in poverty, they are sharing needles
and they're spreading disease as they abuse heroin. And that's
why you're seeing more the rise of more alternative approaches
to heroine treatment that include needle exchange programs where people
(08:58):
heroin attics can come in and get clean needles, because
the logic is, well, you're still going to do the
drug no matter what, but at least you can do
it more safely. Yeah, exactly. Uh. And you know, talking
about safety, we can't stress enough that heroin that you
get off the street is very very very very very
(09:20):
very likely to be laced with toxic additives, things that
might clog your blood vessels permanently damage your organs. One
of the big things that people are talking about right
now is fentanyl that's in a lot, not only heroin,
been in a lot of street drugs, and fentinel for
those of you who don't remember, is what killed Michael Jackson.
It's like the surgical grade anesthesia that is not meant
(09:43):
for recreational use. So a question that we wanted to
answer is why, like what A companies and precedes heroin use,
are there predicting factors leading to this? And research finds
that it is. Are you linked with trauma, especially when
it comes to women. There was a study published in
(10:05):
fourteen in the International Journal of Drug Policy which found
that female drug users disproportionately are likely to have experienced
physical and mental health problems, sexual abuse, or domestic violence. Yeah,
and both men and women did widely report parental divorce,
family addiction, domestic violence, abuse, getting belated at school, being
(10:29):
in the foster care system. And while more women than
men did discuss childhood physical and sexual abuse, there were
plenty of male participants in that study who reported that
they had been abused as children, And I mean these
researchers also note that while on average these are predicting factors,
heroin addicts can also come from very affluent backgrounds, with
(10:54):
two parent households and relatively stable conditions. So it's not
like living in poverty, Um, growing up in poverty necessarily
will lead you down this path, this path to heroin.
But um, generally speaking, there are you know, contributing factors
to it. Yeah, and I mean, like Kristen said, trauma
(11:14):
is a huge one. There was an Australian study UH
in two thousand five of six hundred and fifteen heroin
dependent people, and the researchers found that of those had
experienced trauma at some point in their lives and forty
one percent had experienced PTSD at some point in their lives,
compared to the general populations experience with PTSD at just
(11:38):
seven or eight percent UM. And of those heroin users
who had experienced PTSD in the study, the condition was
chronic for most of them, and they had more extensive
histories of using multiple drugs in addition to experiencing worse
mental and physical health problems and something linked to this
(11:58):
issue of PTSD and trauma is dissociation, and Caroline, I
was not expecting to run across that in our research. UM,
so can you help me understand sort of what dissociation
is in how it relates to all of this. Yeah, well, so,
first of all, women are way more likely to develop
(12:18):
PTSD according to this Australian study, UM and dissociation is
super commonly aligned with the development of PTSD. And this
is basically when you have started a defense mechanism. It's
when you separate yourself from your awareness of something. So
to give like a really mild, non dangerous example, day
(12:42):
dreaming is almost a type of dissociation, like you're not
aware of your surroundings. Have you ever gotten road amnesia,
where like you're driving somewhere and you look up and
you're like, oh my god, it's been fifteen minutes and
I don't even remember the last couple of miles of
my drive. I'm nodding vigorously to Caroline. Yes, yeah, that
is a type of dissociation. UM. It goes all the
(13:05):
way up to its most severe and chronic form, which
is multiple personality disorder. But basically, UM people who experience trauma,
one of their primary defenses, especially as children, is dissociation.
It's when you basically cannot deal with the circumstances around you,
particularly in an abusive home, and so you kind of
(13:27):
retreat into yourself. It's almost like you're watching a movie
of yourself as a way to kind of insulate your brain,
insulate your feelings so that you can sort of deal
with this unhealthy situation around you. But the thing is,
researchers are saying that trauma survivors heroin use might actually
be an attempt to reduce the earlier trauma's effects. And
(13:51):
this is what they refer to as chemical dissociation versus
the psychological dissociation that you know you will see children
and abuse of homes experience, and when it comes to adults,
if you've never learned to deal with your trauma, or
you know, face difficult situations head on and overcome your
habit for lack of a better word, of dissociating from
(14:14):
traumatic experiences, you might just continue to dissociate and that
could potentially lead to multiple personality disorders. But it's all
very wrapped up in trauma and then in heroin useed
so is this U fancier term for self medication. Yeah, basically,
(14:34):
especially because it's also linked Heroin uses also linked to
things like anxiety and depressions. So there was this big
Illinois study from looking at heroin users in and around Chicago,
particularly actually the around parts, so a lot of them
were in the suburbs. Uh, And they found that more
than seventy of the sample self reported or exhibited symptoms
(14:57):
of mental health disorders like anxiety, depression, bipolar disorder, and
a d H d UH. And they found that women
were actually slightly more likely to have a co occurring disorder.
But the majority of the participants in that study said
that heroin youth provided them relief from their worries and
(15:17):
anxieties because heroin when you use it, when you use it,
it provides both pain relief but also detachment from emotions,
so it provides that chemical dissociation that those other researchers
were talking to. And many of the people in that
study also exhibited sensation seeking behaviors to and that's a
point that we'll revisit later when we're talking about heroin's
(15:41):
explosion in more rural settings. So if we look at
this epidemic of heroin youth sets happening right now and
how it relates to the so called war on drugs. Um,
we see some changes in how it's portrayed, kind of
who is representative of that, and also how it's being approached. So,
(16:05):
first of all, the rise of heroin has been tied
directly to the use of and more specifically, the crackdown
on prescription painkillers, particularly OxyContin. UH of recent heroin users
say that they switched to heroin after first trying prescription
pain killers, and uh, anecdotally, I was talking to a
(16:29):
friend about this episode that we were about to come
in and record, and she was saying, oh, absolutely. A
family member of hers um started taking pills when he
was in high school, and he came from a very
affluent family, went to a nice school, and very quickly
(16:50):
the kids he was hanging out with were like, oh,
you know what, these pain killers are fine, but have
you ever tried heroin. It's actually cheaper, and you know,
you start sorting it and then next thing you know,
he's in and out of rehab. Yeah, there's I mean
not to like spoil the rest of the episode or anything,
but I mean there's a whole lot of like class
(17:12):
access issues wrapped up in this because you know, it
is way more We don't have to tell you this.
I mean, it is way more quote unquote socially acceptable
to first take pain killers at all for anything, because
your doctor gives them to you, presumably you've got insurance.
You go to the doctor, you get your pain killers,
(17:33):
and then you just keep using them and it it
almost is like a fashionable thing. It's like going back
to Mommy's little helpers, you know, the the what is
it the Viking d or Vali vallium from the sixties
and seventies that the housewives were getting. Uh but at
some point when that becomes too expensive. But but it's
(17:55):
or if you're just chasing a different high. Yeah, like
it's okay to abuse pain pillars because a little harroin.
That's what poor people do. But as we're seeing like
all of these weird classes, assumptions about drug use and
abuse are definitely flying out the window. Oh, I wouldn't
say they're weird. I think more specifically, I was just racist.
So yeah, for sure, just racist. But this reminds me
(18:17):
of what I was telling you a couple of days ago,
when I was early in high school and I was
trying to impress a dude that I thought was cute
by talking about weed and smoking weed, and he was like,
you know, I'm really over that now and I was
(18:37):
like oh, and he was like, yeah, I'm just we're
into pills, and I you know, I was I think
sixteen maybe at the time, and just slowly backed away
because I was like, I don't you mean like i'd
be profound. I like, I don't why. I don't understand it,
but it's so so common and I'm talking to like
a middle class white dude. Yeah, I'm such like a
(19:00):
sheltered goody two shoes though, like hearing someone. If I
had heard someone say that to me, I would have
been like, but you don't know what it's going to
do to you. Oh. I thought the same thing. I
was like, why why would you do that? Um? And
I would so what if it's a blood cinner or diuretic.
I would like to report though, that both of these
guys that I've just referenced are like fully recovered and
(19:22):
they're both half away married and doing great, so good
for them. Not everybody is. Uh So, if we look
back at two thousand nine, uh, there were two hundred
and fifty seven million prescriptions for pain killers dispensed, and
that was up forty eight percent from just nine years earlier.
(19:45):
And in enough pain killers were prescribed to treat all
two d forty two million adult Americans around the clock
for a month. In other words, reading between the lines,
a lot of those pain killers were being averted to
illicit and illegal uses. Yeah. And when I first read
(20:06):
those statistics, UM, I was astonished first and then wondering,
how is it possible that so many pain killers are
being prescribed. I have a story. Oh well, a former
coworker of mine UM at a previous job, UM had
surgery and she was given pain killers to deal with
(20:28):
her surgery. And I'm not kidding you, dude, Like you
know you for anyone who's ever had surgery before, you
get a certain amount of pain killers and maybe you
can get them reapt like once if you're the pain
is really bad, or if you get infection or something
that needs pain killers. Um, she was calling like twice
a month, and her doctor was refilling it every time.
(20:53):
Pill mills total pill mills situation. She ended up getting
fired for abusing pain killers at work, and and she
was a middle class, middle aged white woman, and she
had health insurance, and she had health insurance well. And
we see though, all of this spiking, particularly in more
(21:15):
rural areas because, come to find out in the two thousands,
you know, doctors, uh, we're having trouble directly treating issues
in rural areas because they're more remote, and so they
would just write a bunch of prescriptions for pain killers
just cover up the pain. We especially if you're spread thin,
you know, you might be the only doctor in the
(21:36):
area for for for a long stretch, and so if
you're overworked, if your patients are complaining of chronic pain,
or if maybe you're just not a great doctor or
responsible doctor, that too. But yeah, so more and more though,
women have been the ones abusing pain killers in particular.
According to the cdc UH, men still overdose on prescription
(21:59):
pain killers more often, but the number of women who
are dying from prescription drug overdoses jumped four hundred percent
between compared to two for men, and that highest jump
for prescription drug overdose death was among women to fifty four.
(22:20):
By every day, eighteen women in this country were dying
from prescription drug overdoses and uh, you know the thing there,
in terms of going to your doctor, getting pain killers
and then developing an addiction, women are more likely to
suffer from chronic pain. They are more likely to then
(22:41):
be prescribed pain killers and for a longer amount of time,
and we tend to develop dependency issues faster, particularly not
only to opioids, but also to alcohol and marijuana thanks
to physiological differences that separate us from men folk. Basically
that we just hold on to those substances in our
systems longer. Just side note, I really appreciate your use
(23:04):
of men folks. Yeah, and it's like really serious discussion
the men folks men folk. But another key factor to
this puzzle is that the majority of overdoses happen when
those prescription pain killers are combined with other depressants like
alcohol or sedatives like ambient and xanax. You probably can
see where this is going because women are twice as
(23:25):
likely as men to have anxiety and seventy more likely
to have depression, which means they get more of those medications,
which means if they are also taking pain killers, they
are more likely to experience dangerous drag interactions. And throughout
all of this research I kept thinking about Amy Winehouse
and watching the Amy documentary, which I do highly recommend
(23:47):
if you're whether or not you're a wine House fan, um,
because her official cause of death was alcohol. But like this,
the majority of ODIs are happening because you are xing things.
Obviously she had had, you know, problems with heroin and
cocaine and like all sorts of other hard drugs as
well well, especially if you are building up that tolerance
(24:11):
because suddenly the amount that you're using is so much
higher than what you started at, but you don't feel
as good, so to speak. And considering those physiological sex differences,
you know, with our tolerance being lower than men typically,
whether we're talking about booze or something like heroin. You know,
thinking about Amy Winehouse before she tied to me, she
(24:32):
was tiny. She was already like a small woman, but
she was just skin and bump. Yeah, And you know,
we we've focused this this episode is focusing mainly on
on women versus men, but we also have to talk
about l g B t Q folks. They are nine
and a half times likelier to use heroin than straight
men and women, and a lot of that relates back
(24:55):
to all those mental health co occurring conditions we talked
about earlier, anxiety and depression, things that stem from the
daily exposure to homophobia, discrimination, the threat of violence. It's
just one more thing that that community has to deal with.
So as issues of you know, this painkiller addiction epidemic
(25:17):
started to rise on regulators radars, you have the crackdown
on OxyContin, so the manufacturer has reformulated it to try
to make it less habit forming um. And what happens
is that if you now try to crush it up,
it turns into a gummy substance, and that is to
(25:40):
discourage people from being able to snort it. But there
was a story on NPR not too long ago. They
did a whole series on the heroine epidemic and they
were shadowing woman who had the new oxycont pills. And
they've already figured out a way around, you know, the
(26:00):
the gummy stuff. I think that they now just uh
burn it, oh, you know, then smoke it. Yeah. So well,
because of those changes to the drug that make it
more difficult to abuse, you see black market pharmaceuticals price spiking,
(26:21):
and basically right after that, you see cartels moving into
more rural areas suburban and rural areas from places like
New York because suddenly there's a new market for heroin
and it's a wider and more diverse market than ever before.
So that's where you get this explosion. In these majority
(26:41):
white rural areas. They typically have police forces that are
spread way too thin. Um And like Vermont and New
Hampshire are kind of leading the way in this unfortunately.
Um And it was in an article in Rolling Stone
that we were reading about this explosion in Vermont that
(27:01):
cited one gay man who was, like, dude, it is
so boring up here, Like I have no social life,
no sex life, nothing. And that's not to like pin
anything on on gay men, you know, certainly not. But
there's that goes back to that whole sensation seeking attribute
that we mentioned earlier that whether you are gay, straight, whatever,
(27:24):
if you feel isolated and are looking for some change
for change's sake, a lot of people are turning to
drug use. I mean, and that's that's not surprising to hear.
I mean, I think that you see that in smaller towns,
even if we're just talking about alcohol. You know, it's
like the image of what are we gonna do. Let's
(27:45):
just hang out on the Walmart parking lot and drink
some for days. You know, boredom You telling me about
your childhood condor. Uh, it was cobra malt liquor and
peach snaps and a cul de sac and not the
Walmart parking lot. But yes, a little bit. That's like
a country song. Well, we were in a relatively country town, Caroline.
(28:06):
But this is something echoed by Matthew Birmingham, who is
commander of the Vermont Drug Task Force, saying I think
he was speaking to rolling Stones, saying that listen, especially
when we're young, there's that feeling of being removed from
the world and there's a lack of you know, feeling
like they're going to be consequences to what you're doing.
You're almost invincible. Yeah, there is that that kittitude. Kittitude,
(28:30):
lose the kittitude sometimes I need a little more kittitude.
I know there's a balance, definitely. Yeah. And Birmingham's statement
was echoed by Jesse Farnsworth, who works at the Howard Center,
an organization that runs treatment clinics in Vermont, and Jesse
just said that you know, kids today don't feel like
they're a part of anything. And when people feel isolated,
(28:51):
it's easy to want an escape from reality. I mean,
that's not saying that any person who feels isolated, bored,
or whatever is going to immediately turn to heroin. But
when you do have this explosion of heroin alongside people
who perhaps are already using painkillers or perhaps seeking a
new experience, that's like, that's a terrible combination of opportunity.
(29:13):
And now that we have sort of laid out the
general landscape of what's happening with the heroine epidemic, particularly
in the United States and international, listeners really interested to
hear from you on this in Canada, that includes you. Um,
but we're gonna take a quick break and come back
and spend the rest of the episode really focusing on
(29:35):
heroin as it relates to women. So, in the nineteen fifties,
women made up just of haroin users, but now we
(29:57):
are a majority, we make up more more than Yeah,
that's a that's a gender gap that didn't need to
be closed, I know. Uh. And if you're looking at
the average first time heroin user, that person is most
likely a twenty three year old white woman. According to
the Journal of the American Medical Association psychiatry. And Uh,
(30:21):
one fact that I hadn't really thought of that came
up in that Rolling Stone article about the heroin epidemic
is that, you know, you have all these cartels and
drug dealers moving into more suburban and rural areas from
cities because they have all of these new markets that
aren't really being policed maybe as strongly as some of
the urban markets. And they're recruiting a lot of these
(30:43):
average twenty three year old, fresh faced white ladies to
traffic a lot of their drugs because like because white privilege,
I don't know, because police are less likely to look
at some um white girl and be like, oh, you
must be trafficking heroin in your car, speaking of traffic.
Doesn't the movie Traffic also have a plot line where
(31:05):
it's the fresh faced, blonde white girl who is addicted
to heroin. Oh, I don't know, I've never seen it. Finally,
a movie you've seen that I've seen that you haven't.
I know, Listeners isn't such a rare occurrence. Oh wow, Uh,
it might not even be traffic, But I know there's
a movie where that is the case. Um, and it
(31:28):
seems like too. When we read about these white young women,
it's also implied that they are cis gender and usually
straight white young women as well. And I think that's
part of the reason why people are so concerned about this,
because it's like, oh, well, if if these these women
are doing it, then it must be a problem. Yeah.
(31:48):
I mean the other side of that too, is that,
as that article pointed out, you know, because the heroin
abuse epidemic is now aligning itself with what used to
be the prescription painkiller epidemic. You know, you've got a
lot of folks with disposable incomes who can afford to
head off to rehab or can continue to get high
(32:10):
without needing to resort to crime to get money to
score their next batch of heroin. Or on the flip
side of that, if your forty dollar a pill uh
oxycotton or vicodin or percoset, whatever is costing you too much,
guess what's cheaper now, you know, heroin. So it's become
(32:30):
a last resort for people who we're hooked on painkillers
but need something cheaper and more accessible but equally strong,
if not stronger, So they go for heroin. Yeah, but
but it's gonna be laced with stuff you guys, and
I'm gonna get in your brain. I uh, please don't
your heroin. Um. But but women are more likely to
(32:52):
be introduced to heroin injection, in particular by a sexual partner, uh,
and more likely to report feeling social pressure as a
result of it to the National Institutes of Health. And
that is what made me think of Amy Winehouse with
her Her ex husband, Blake has now publicly said that
Amy Winehouse first said heroin, you know, under his influence
(33:15):
because he did it first, and then they became a
heroin addicts together. He claims that they were shooting up
regularly for only, in quotes four months, and that she
was actually worse when he was in jail. But if
anyone who knows anything about Amy Winehouse and Blake Fielder
civil is that his last name, uh knows that you
(33:36):
can trust what Blake says about as far as you
can throw him. Ditto her father. But of course this
isn't just a factor for celebrity couples. I mean, this
is still the whole the whole issue of it being
something that happens in sexual relationships is a pretty common hallmark,
especially when we're talking about women in heroin. Yeah, and
(33:57):
when we are talking about women in heroine, we tended
it and smaller doses, which could explain why men are
still four times as likely to die from a heroin
overdose the women are um And Earlier studies, also, like
from the drew some distinctions about how women use it.
Uh So, not only you know, are we likely to
get it from a sexual or romantic partner who's also
a drug user, but women are more likely to share
(34:19):
needles and received previously used injection equipment. And that's obviously
a major red flag for the spread of disease. But
going back to that International Journal of Drug Policy study,
there was something there was an attribute of this of
heroin use and abuse and dependency and recovery that I
had not considered at all before, which is social pressures
(34:41):
around appearance. So they found that both men and women
tended to ignore personal appearance issues during those periods of
heavy use. But regardless, women still remained more concerned about
appearance both during use and during recovery. And there was
this big concern that as soon as they stopped using
(35:03):
and they're gaining that healthy weight back that they had
lost when they were abusing drugs that they were going
to look fat, and so then you have the added
layer on top of struggling in recovery, you've got the
add a layer of eating disorders that tend to surface
among people who are afraid of getting fat. First is
the men who tended to like the added weight. They
(35:23):
were like, yeah, I'm getting compliments on how healthy I look,
so I must be getting better. So that's the weight game.
For men was an encouraging and supporting factor to getting better,
but for women it was almost discouraging. Well, and then
if we look at pregnant women, no surprise here that
heroin use is associated with low birth weight. UH. Infants
born dependent on heroin um babies can suffer from neonatal
(35:48):
abstinence syndrome, which is essentially when babies are born going
through drug withdrawal and so they're crying constantly and are
just in physical pain. Yeah, And the thing is, like,
speaking of the nineties, it really wasn't until around the
nineties that women's addiction issues in general got specific attention,
(36:09):
and a woman centric push was super necessary because that
early addiction literature either ignored them or portrayed them as
weaken and secure or somehow sicker and more disturbed than
male addicts. And women, they found have specific hurdles to
support and treatment and getting recovery that include social stigma.
(36:32):
You you're a bad woman or a bad mother if
you let yourself get addicted to something. You've got issues
of childcare because hello, women are more likely to be
the ones responsible for it. So it's not like if
you've got three kids, but you're addicted to a substance,
including heroin, you know, maybe you feel you can't stop
everything and go to a center of some sort of
(36:53):
recovery facility. You've also got issues of transportation and unemployment.
You know, you might lose your job or be unable
to find a job when you're stopping everything to try
to get recovered. Yeah, I mean there there is that
gendered stigma on female drug abusers, um, whether it's heroin
(37:14):
or any kind of drug, because I think we do
still perceive, you know, female drug addicts as more deviant
than men. It's like violating all of those feminine norms.
Weren't we supposed to be the moral centers of society? Well,
and if anything, the stereotype is that you are a
Valley of the dolls, like Mother's Little Helper, uh, Viking
(37:36):
and valium user. You know, like it's okay to stay
at home and take your little pink happy pill. But
heroin that's that's like aggressive. Yeah, I mean I also, Yeah,
I feel like anytime you have drug abuse and motherhood combined,
the stigma is doubled and tripled. But unfortunately it's often
something that goes hand in hand. Yeah. And that International
(37:59):
Journal of Drug Policy study also pointed out the whole
thing with appearance and weight and drug using stigma. Uh,
all of that affects a woman's cultural capital, and that is,
as we were talking about, a potential hurdle to recovery. Uh.
They wrote that if society has more onerous expectations of
(38:20):
women than men in terms of their appearance, behaviors, or
carrying obligations to others, this is likely to place more
material and psychological demands on women in recovery. So basically, like,
don't forget to smile. I'm saying that as a stand
in for like, make sure that you're thin and pretty
and a good mother, and that you're healthy and that
you've got a job. All of these extra expectations like
(38:44):
don't forget to put on your lipstick. A plus side
when it comes to gender and drug abuse, though, is
that the same study we've been citing a lot found
that women do report more informal support, having an easier
time making non user friends, and are likelier to say
that their kids motivate them to kick the habit and
(39:07):
stay quean. Yeah, and there's actually, I mean, speaking of
women and kids, there's a great example of treatment coming
out of Iowa. It's this place called the Heart of Iowa.
It's a residential program for women with kids. UM. It
doesn't only treat heroin users. It treats women with a
variety of substance abuse issues. But it's been around for
(39:28):
like twenty years. UM. It was created in response to
a high percentage of women who were opting out of
residential treatment facilities because they didn't want to have to
abandon their children to foster care. UH. There are fewer
than twelve programs like this in Iowa, which means there's
a huge waiting list, which of course can complicate recovery. UM.
(39:48):
There are other programs that you have to be like
a certain amount pregnant, you have to be like a
certain amount into your pregnancy before they'll accept you. So
that like dead space ace of having to wait until
you're somehow pregnant enough to go into the facility can
also complicate recovery. But at this heart of Iowa Place,
(40:09):
I mean, the women have full days from eight thirty
to seven at night. Um, they have a comprehensive curriculum
where they can learn strategies for relapse prevention, even how
to quit smoking, but also how to budget and and
parenting skills. They can attend group therapy, individual counseling, and
the facility even has like an outreach branch that can
also reach the partners and or spouses of these women
(40:33):
in different facilities, so that there's a more holistic, whole
family approach to recovery. But I mean they also get
mental health counseling, life skills training, on site childcare, and
and most importantly those furnished on site apartments that let
the women have the dignity of a private space that
they can return to at night after the day is over. Yeah,
(40:55):
I mean this sounds like like the ideal situation for
an excessive bowl rehabilitation facility. I'm not not talking about
like a celebrityhab you know, bazillions of dollars kind of place.
But unfortunately, I mean, all of that relies so much
on how many you know, how much government funds are
available to make that happen, And a lot of times
(41:17):
the answer is there's there's not too much, especially as
the demand is increasing UM. And that leads us to
questions about medication for treatment. Because you have methodone, which
is probably the heroin treatment medication we're most familiar with UM.
There's also a newer one called bupren nor Fine. There's
(41:41):
also now trek zone that act on the same parts
of the brain that heroin does. But both methodone and
buprenorphine suppressed withdrawal symptoms and relief cravings. Now trek zone
blocks those opioid receptors. And if I'm recalling correctly, one
big prints between methodone, which can be addictive UM and
(42:04):
buprenorphine is that beauprenorphine does not UH, it blocks the
same like drug and reward pathways that methodone does. That
can lead to more addiction. Right, And there's questions too,
you know, when you talk about UM parents, women with
children of whether methodone and buprenorphine are safe for pregnant women,
(42:28):
and methodone is definitely still the preferred and recommended treatment,
although it is associated with that neonatal abstinate syndrome that
can affect newborns. And there was actually study that found
that compared with methodone, buprinorphine was actually better than methodone
in reducing those withdrawal symptoms in newborns. But a lot
(42:49):
of doctors are are uncomfortable using it just because it's
it hasn't been as extensively used in pregnant women, so
there's still some question. Um, you also have no locksone,
which is used as an emergency treatment to counteract the
effects of an o D, And there have been a
lot of articles and NPR segments, segments for instance, that
I've heard about police forces and outreach groups carrying shots
(43:14):
of alex and with them so if they encounter someone
on the street who is experiencing an overdose, they can
inject them with this rather than just either letting the
person die or shipping them off to jail immediately. Yeah,
so speaking of jail, I mean, this is such a
complicated issue when it comes to pregnant women. Um, pregnant
(43:36):
addicts in particular because you have states like Tennessee, which
became the first state to pass a law that would
punish drug addicted pregnant women. So pregnant women who take
narcotics can be charged with aggravated assault to their fetus.
But it has no targeted drug treatment programs for pregnant
(43:58):
women rather than treating the to you, you're just sending
them to jail, and that it's not going to solve
anything in NBR, We're gonna keep reverencing NPR. This episode
was brought to you essentially by like Morning Edition and Marketplace,
because I believe it was on Marketplace or either that
are all things considered. I forget because they come on
back to back every evening here in Atlanta. But they
(44:19):
did a whole heartbreaking but such important series on these
women who are become addicted to heroin. They become pregnant,
and they have to make this choice between going to
the doctor and then finding out that they are addicts
and then them being sent off to jail or trying
(44:43):
to manage their addiction through a pregnancy, and then of
course when they deliver, if they go deliver at a hospital,
they might be you know, risking being arrested as well. Yeah,
the article that we were reading about that Tennessee law
made the very important point that the states that punish
(45:04):
pregnant women who are addicted to drugs or alcohol tend
to be the states that lack any sort of supportive
treatment program for such women. It's not like, oh, well,
we're gonna try to treat you, and if you're still
abusing medications, then we'll send you to jail because we
tried our best. There's there's no try try harder. And again,
(45:26):
it's just punish the pregnant women for what they're doing
to their fetus. And since the heroin epidemic has been
so predominant among white people, you have more white middle
class families publicly raising their voices against tough war on
drugs policies, advocating for classifying heroindependence as a disease not
(45:50):
a crime, and they're lobbying state houses, holding rallies, and
starting nonprofits. And uh, it's quite a shift from what
a lot of white middle class families thought about tough
war on drugs policies when a lot of the people
being arrested were people of color. Yeah, oh, it's it's
(46:11):
a complete one eighty because now you're having more of
these white families losing family members to heroin, whether it
is death, an overdose, or whether it is going to prison.
The White House drugs are Michael Boticelli was very explicit.
He was like, Yeah, these people know how to call
(46:32):
a legislator, they know how to get angry with their
insurance company, they know how to advocate, and they have
been so instrumental in changing the conversation. And it's interesting
to see the effect these families are having in this
push to move heroin abuse away from being a crime
and more toward a disease. You know, we cited that
study out of Illinois at the top of the podcast.
(46:54):
It was actually I mean, yes, it was done by
a foundation, but it was actually funded by like parents
and grandparents. They helped fund this investigation into used and
abuse of heroin by suburban people. Uh, and you know,
they found all of these important aspects of it about
like young people who don't see the consequences of their
(47:16):
heroin use and abuse, about sensation seeking among young people
in suburban areas. And I mean, where was that for
the crack epidemic or really any other drugdemic. Including heroin
twenty years ago. Yeah. I mean that just throws all
of the classism and racism wrapped up in our drug
(47:36):
policies into stark relief. I mean, and and drugs are Botticelli.
He called it like he saw it. I mean, he
said quote because the demographics of people affected are more white,
more middle class. These are parents who are empowered. So
I mean, I absolutely support the concept of classifying heroin
(47:59):
dependence in other drug dependencies as diseases and treating them
as such. Um, and steering away from the criminality aspect
of just throwing them in prison and letting taxpayers pay
far more for imprisoning them than it costs to treat people. Um.
(48:19):
But I think we also have to take a step
back to and ask that question that you just did
of like, well, why are recently paying attention to this now?
And maybe we need to also, uh spread these resources
and all of this interest not only to white heroin
addicts in suburbia, but also to more inner city areas
(48:42):
that have drug problems but they don't have all of
those well funded grandparents who can somehow contact a foundation
and pay for a study. Yeah. And this is something
that Kimberly Williams Crenshaw brought up. She specializes in racial
issues at Columbia and U c l A Law schools.
She is also if you're like that name sounds familiar
(49:03):
to me as a seminty listener who's well educated and
curious about life. Uh cringe. Shaw also introduced intersectionality to
feminist theory. Hello, but she says this new turn to
a more compassionate view of those addicted to heroin is welcome,
but one cannot help notice that had this compassion existed
for African Americans caught up in addiction and the behaviors
(49:25):
that produces the devastating impact of mass incarceration upon entire
communities would never have happened. Oh yeah, I mean, like
there there are so many aspects of of privilege coming
up in this and and again it's not to say like, oh,
white people don't deserve any help for their drug addiction,
but it's like we've got to look at the whole system,
(49:46):
because the whole system is broken. UM. And how you
have a lot of these UM activist parents who have
lost children to hero and epidemics. UM. Even just paying
attention to language preferring to use words like addict in
lieu of junkie. Yeah. Yeah, well yeah, you know, and um,
(50:07):
I mean, one thing I want to say about all
of this too is um as it also kind of
relates to issues with STDs and her pies, things that
are really common but highly highly highly stigmatized because of
a lot of misunderstanding and silence around it. Heroin UM
doesn't necessarily connote homeless person, you know, prone to crime,
(50:33):
sitting on the corner. Yeah, as Yeah, most drugs don't
necessarily connote that, right, And we need to re you know,
and we need to collectively shift our mindsets away from
that because in a lot of ways, that is very
classics and prejudice. Because I have seen heroin. I've seen
it at a party with my own eyes and seen
people who are on heroin, and I have known people
(50:55):
who have gone to rehab for heroin UM and all
of those people I'm talking about our white middle class
and a lot of them college educated. Yeah, And I
mean I think, you know, we talk about the important
shifts that we need, and the demographic shift is behind
a lot of changing policies. I mean, you know, Vermont
(51:19):
heroin US is now so concentrated in that tiny state
of Vermont that their governor, Peter Shimlin, for instance, is
now expanding treatment programs and helping addicts get into those
programs instead of just sending them to prison. And these
are tactics that on the national level, people are starting
to take notice of and saying, oh, maybe we do
(51:42):
need to treat the root causes of addiction. We need
to focus our money and energy and effort on mental
health counseling and support. We need to understand mental health
and trauma better. We need to support people who have
been led to abuse substances rather than treating them as criminals,
(52:03):
because that doesn't really Throwing people into jail does not
fix any of these root causes. We zeero it in
on trauma early in the podcast because it's important to
talk about that because trauma doesn't only affect someone you know,
in a poor area of town. Trauma cuts across every
type of demographic and so as does the use of
(52:25):
multiple kinds of drugs, which is also a predictor for
heroin use. I mean, this is nothing that's exclusive to
one demographic. Yeah, I mean, and especially when it comes
to heroin and opiate addiction. Your chances for relapse are
so high that if we treat it, you know, solely
by tossing them in jail, you're gonna have a high
recidivism rate. You know, it's gonna happen. And I mean
(52:48):
treating it more as an addiction and a health issue
is going to be more cost effective overall for all
of us because these are our taxpayer dollars paying for it.
Because you have to remember that this is not an
individual problem, one person's, one woman's uh. Heroin addiction can
potentially be the spoken you know, a whole wheel of
(53:10):
issues such as sex, work and a s CDs and
childcare and on and on and on, and we're we're
a community here, we're all affected by this, and like
just stigmatizing this one group and saying like, oh, they're
just broken, horrible people. Just get them out of my sight.
Like just because we don't see them doesn't mean that
(53:32):
the problem goes away exactly. And that's why you see
like in places like Seattle, which I think is the
first to try this, maybe Vancouver also in Canada, but
the Seattle Mayor is actually backed opening safe consumption sites
for addicts, places where um, you can get clean needles
and supervision and anti O D medications UM. But basically,
(53:58):
you know, addiction and crim records can keep a lot
of addicts out of shelters and out of facilities and
things like that, UM, And so like, how is that
helping anyone? Because then you are likely to see the
domino effect of you know, staying on the streets, continuing
to uh, potentially use unsafe needles and practices, um, getting
(54:22):
jailed for your drug use and and the cycle just continues.
So it'll be interesting to see what the effects are
if if the Seattle Safe Consumption Site thing goes through well,
and that's also going to depend on what local communities
decide on because it might have been in West Virginia
or Vermont. This was something that came up in that
(54:43):
Rolling Stone article where a rehab facility specifically for heroine,
like a treatment center was going to open in the
small town where there had been a massive problem with heroin.
But the people living there like vetoed it because they're like,
we don't that here, we don't want those, you know,
just attracting more addicts. Was like there's a backwards I know,
(55:07):
and that's the stigma at work, and I I mean,
I want to hear from listeners about this because I'm
sure there are so many complexities to this issue, especially
when it comes to treatment UM that we haven't acknowledged UM.
So yeah, I mean, I just want to open this
(55:28):
up now to listeners this year. What you think, especially
because we have such a geographically diverse audience that we
probably have people listening right now who are in towns
in areas where heroin has become more of a problem UM,
or if you were in an area where you've had
a successful treatment systems set up, or if you just
(55:53):
know someone who's dealt with this. We want to hear
everything that you'd like to share with us. Mom Stuff
at how stuff works dot com is our email address.
You can also tweet us at mom Stuff podcast or
messages on Facebook. And we've got a couple of messages
to share with you right now. Okay, I have a
(56:14):
letter here from Sarah. She was writing into us in
response to our Libido Liberation episode where we talked to
Maria Finitzo, who's a filmmaker, UM, and she wants to
write us about the misconception about the Immaculate conception. And
Sarah was not the only person to write in about this,
so I definitely wanted to address this point that she made.
(56:38):
She said, I wanted to point out a mistake that
many people make with the term immaculate conception. Many people
believe that this refers to the sex reconception of Jesus
that preserves Mary's virginity. This would be the doctrine of incarnation. However,
the immaculate conception actually refers to the conception of Mary herself.
Mary was conceived by normal biological means by her parents,
(56:59):
but God made it so that she was free from
original sin because she would later become the mother of
Jesus Christ. In Catholic doctrine, original sin is something that
all men and women are born with as a result
of the disobedience of Adam and Eve and their fall
from Eden. Well, a big to do is made about
Mary being a virgin when she gives birth to Jesus.
The immaculate conception is a reference to her own purity
and elevation above all other mortal men and women. This
(57:22):
is what makes her worthy of being the mother of
Christ and upholding a very high place of reverence within
the Catholic Church. My mother was raised to strict Catholic.
While she no longer considers herself one, she still has
a strong respect for many of their philosophies. She was
the first person to point out to me that so
many people don't use the Immaculate Conception correctly. I find
theology fascinating and loved reading about this. After she corrected me,
(57:43):
keep up the good work. I look forward to diving
into your latest podcast about Lisa Frank, Oh Sarah, speaking
of Lisa Frank and then therefore speaking of unicorns, I
hope that you also find our conversation about unicorns and
Jesus and purity and ruginity interesting in that episode as well.
Oh man, Jesus and unicorns, what a combo? I have
(58:06):
a letter here from a Christian with a K about
our episode on exercise and breasts, subject line Army boobs.
She writes, I was in the Army for eight years
and always struggled with the classic Army activity of running.
It took about two years of running with massive groups
of people, primarily men, before I was alerted to what
(58:29):
was holding me back. One day after a rough run,
a senior ranking man came up to me and studies
life changing words listen. None of these other guys are
going to tell you this, but you need to know
your run sucks because you're cradling your boobs instead of
pumping your arms, and you don't even realize it. I
took a quick job to see if he was right,
and by golly, he was. I felt like I was
(58:51):
pumping my arms, but I was actually cradling my c
slash d cups with my forearms. I quickly went and
got myself some new, better fitting sports bra and my
runtime immediately improved. Huh, what do you know? And hey,
you know what red dude alert for, like talking to
a woman about her breasts in a respectful manner and
(59:12):
pulling her aside. Yeah, and not shaming her. Man. Well done, dude,
she says. I love you, ladies, and thanks for what
you're doing. Well, thanks for sharing that with us, Chris
sincas Um, I have a feeling that that might set
off a lightbulb in some other runners ears as they're
hearing this. And now I'm curious about my running form.
(59:34):
But if you have any tips to share with us
on running or just anything at all, Mom stuff at
how stuff works dot com is our email address and
for links to all of our social media as well
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So you can learn more about women in the heroin epidemic,
head on over to Stuff Mom Never Told You dot com.
(59:58):
For more on this and thousands of other topics, visit
how stuff Works dot com
Welcome to Stuff Mom Never told You from how stup
works dot com. Hello, and welcome to the podcast. I'm
Kristen and I'm Caroline. And a quick word of caution
before we get going that this episode is going to
talk a lot about hard drug use, specifically heroin use,
(00:26):
abuse and recovery. So if that is a topic that
you would prefer to avoid listening to for whatever reason,
totally fine. You have been warned. And let's get into
this really serious issue that has just skyrocketed in recent years. Yeah,
heroin use has really taken off in the US for
(00:48):
a lot of sort of uh intermingling reasons, um, And
it has really taken off too, among women in this country,
and so we thought it was time. As almost depressing
and sad as this topic can be, we thought that
it was really important to address it because we want
to better understand and we want you to better understand
(01:11):
what is behind more women abusing heroin and it's specifically
white women. And it's something too that's been in the
news so much. Um. President Obama really launched an anti
heroin initiative some months back, and I remember hearing, you know,
(01:31):
all of these press conferences about it and um, a
lot of politicians talking about it, both on the national
scale and also on the state level. And at the time,
I was a little mystified, thinking heroin, why, Okay, what,
what's behind this? What's going on back we're having a
nineties revival? Yeah, I mean, it just seems like such
(01:52):
an extreme drug. And this, really, you know, points my
ignorance about the issue because I did not understand and uh,
the very practical, unfortunately reason why there is a heroin
epidemic happening. Yeah, so let's hit you with some numbers. Basically,
heroin used in this country has increased across all demographics.
(02:14):
Three out of a thousand Americans said that they had
used heroin in which is the most recent year the
data is available, up from one in a thousand a
decade earlier. And while it remains highest among men, people
eighteen to twenty five, people who make less than twenty
k a year, people living in cities, and people who
(02:35):
are uninsured or on Medicaid, the greatest increases have been
seen among people who have historically had lower rates of use. Specifically,
it has doubled among women and more than doubled among
non Hispanic white people and This isn't just an issue
of people trying heroin once and then walking away. Um
(02:57):
as I think a lot of people know hair one
is extremely addictive. Nicotine is the only drug that we
know of it is more addictive in fact than heroin.
And heroin abuse and dependency jumped thirty five point seven
percent since two thousand eight to two thousand ten. And
about a quarter of people who try heroin just just
(03:19):
that once, perhaps thinking, will become dependent on it. And
that means we're having more overdoses and more death from overdoses. Yeah,
that's right. Uh. In two thousand two, Uh, there were
just over two thousand overdose deaths and that jumped to
more than ten thousand. And if you look at particular states,
(03:43):
you can see where heroin is just gripping towns, and
West Virginia in particular has been in the news this
past August and because the state has seen heroin overdose
deaths triple from two thousand nine to two thousand fourteen.
And on August fifteen, two thousand sixteen, twenty seven people
(04:09):
in this tiny West Virginia town called Huntington's overdosed one fatally,
all because of a bad batch of heroine that was
going around. Yeah, and if you look globally, opiate use
has been pretty stable at about seventeen million in fourteen,
but heroin trafficking has been on the rise. That's a
(04:31):
lot of that's a lot of kind of scary statistics,
a lot of scary numbers that more and more people
are using heroin. Um, but what is it? So let's
get into some DARE one oh one hashtag nineties nostalgia.
That's right, Does DARE still exist? DARE does still exist?
DARE stands for Drug Abuse Resistance Education? Yeah, and it
(04:55):
had you know that there was the red letters, big
DARE letters a black background that I remember seeing so
much around the same time when there were all those commercials,
the p s A s about this is your brain
egg is your brain on drugs? Cracked into the frying pan? Yeah,
And there was the commercial with the woman in the
tank top and she was like smashing up the kitchen. Yeah.
(05:18):
Was that also your brain on drugs? I think it was.
And that was also specifically heroin, I want to say,
which brings us full circle. Although that doesn't sound much
like heroin, which is a type of opioid derived from morphine.
And did you know caroline morphine is organic. It's a
naturally occurring substance extracted from the Asian opium poppies seed pod.
(05:44):
And whether it's organic or not. Uh, if you snort it,
injected or smoke it, heroin gets to your brain really fast,
meaning it is incredibly dangerous and incredibly addictive. So after
that first injection, for instance, users feel this rush of
euphoria and then they chase it after that first time.
(06:06):
But the thing is, it will never feel the same
after the first time that a person does heroin. What
happens is that it hits your brain and converts to morphine.
At that point, it then binds to your opioid receptors,
which are what deal with pain and reward perception. Uh.
And in your brain stem, those opioid receptors are involved
(06:28):
in just like really minor things like blood pressure and breathing,
you know. So what could possibly go wrong? Um? Well,
the thing is, when you're doing it over and over
in order to chase that high, chase that feeling of euphoria,
you build up a tolerance, so you need more and
more to avoid withdrawal symptoms. And those withdrawal symptoms include
(06:49):
things like restlessness, muscle and bone pain, UH, insomnia, diarrhea,
and vomiting. You might also get kicking movements and cold flashes.
But basically what's happening during this point is that your
brain's white matter is deteriorating and this is affecting your
decision making and your behavior regulation and stress responses. And
(07:11):
when you overdose, your breathing becomes suppressed because your brain
isn't getting enough oxygen, which can then lead to psychological
and neurological effects, including permanent brain damage. We cannot over
emphasize the heroin just is not good for you in
any dose. Heroin is not safe. No, please, please do
not do heroin because other side effects also include hepatitis
(07:34):
and HIV, especially since you do get the side effect
of lowered decision making and behavior regulating skills. So uh
if you're sharing needles or engaging in risky sexual behavior. Uh.
People who use heroin also might experience collapsed veins, infection
of the heartlining in valves, miscarriage, liver and kidney disease,
(07:57):
and gastro intestinal problems on top of all of that.
And that reminds me of something that CDC director Dr
Tom Frieden told The New York Times about how when
he was getting into medicine, the AIDS epidemic was happening,
and there was obviously like a lot of issues around
shared needle use with that, and how heartbroken he is
(08:17):
to see a similar issue happening all over again with
shared needles. Yeah, people out there who listen to NPR,
you might have heard the story. This was a couple
of months ago. Maybe there's a town in Indiana where
heroin use has exploded, and in a parallel fashion, so
(08:37):
his HIV. Because there's a lot of people in this
particular community and I can't remember what it is, but
where they are living in poverty, they are sharing needles
and they're spreading disease as they abuse heroin. And that's
why you're seeing more the rise of more alternative approaches
to heroine treatment that include needle exchange programs where people
(08:58):
heroin attics can come in and get clean needles, because
the logic is, well, you're still going to do the
drug no matter what, but at least you can do
it more safely. Yeah, exactly. Uh. And you know, talking
about safety, we can't stress enough that heroin that you
get off the street is very very very very very
(09:20):
very likely to be laced with toxic additives, things that
might clog your blood vessels permanently damage your organs. One
of the big things that people are talking about right
now is fentanyl that's in a lot, not only heroin,
been in a lot of street drugs, and fentinel for
those of you who don't remember, is what killed Michael Jackson.
It's like the surgical grade anesthesia that is not meant
(09:43):
for recreational use. So a question that we wanted to
answer is why, like what A companies and precedes heroin use,
are there predicting factors leading to this? And research finds
that it is. Are you linked with trauma, especially when
it comes to women. There was a study published in
(10:05):
fourteen in the International Journal of Drug Policy which found
that female drug users disproportionately are likely to have experienced
physical and mental health problems, sexual abuse, or domestic violence. Yeah,
and both men and women did widely report parental divorce,
family addiction, domestic violence, abuse, getting belated at school, being
(10:29):
in the foster care system. And while more women than
men did discuss childhood physical and sexual abuse, there were
plenty of male participants in that study who reported that
they had been abused as children, And I mean these
researchers also note that while on average these are predicting factors,
heroin addicts can also come from very affluent backgrounds, with
(10:54):
two parent households and relatively stable conditions. So it's not
like living in poverty, Um, growing up in poverty necessarily
will lead you down this path, this path to heroin.
But um, generally speaking, there are you know, contributing factors
to it. Yeah, and I mean, like Kristen said, trauma
(11:14):
is a huge one. There was an Australian study UH
in two thousand five of six hundred and fifteen heroin
dependent people, and the researchers found that of those had
experienced trauma at some point in their lives and forty
one percent had experienced PTSD at some point in their lives,
compared to the general populations experience with PTSD at just
(11:38):
seven or eight percent UM. And of those heroin users
who had experienced PTSD in the study, the condition was
chronic for most of them, and they had more extensive
histories of using multiple drugs in addition to experiencing worse
mental and physical health problems and something linked to this
(11:58):
issue of PTSD and trauma is dissociation, and Caroline, I
was not expecting to run across that in our research. UM,
so can you help me understand sort of what dissociation
is in how it relates to all of this. Yeah, well, so,
first of all, women are way more likely to develop
(12:18):
PTSD according to this Australian study, UM and dissociation is
super commonly aligned with the development of PTSD. And this
is basically when you have started a defense mechanism. It's
when you separate yourself from your awareness of something. So
to give like a really mild, non dangerous example, day
(12:42):
dreaming is almost a type of dissociation, like you're not
aware of your surroundings. Have you ever gotten road amnesia,
where like you're driving somewhere and you look up and
you're like, oh my god, it's been fifteen minutes and
I don't even remember the last couple of miles of
my drive. I'm nodding vigorously to Caroline. Yes, yeah, that
is a type of dissociation. UM. It goes all the
(13:05):
way up to its most severe and chronic form, which
is multiple personality disorder. But basically, UM people who experience trauma,
one of their primary defenses, especially as children, is dissociation.
It's when you basically cannot deal with the circumstances around you,
particularly in an abusive home, and so you kind of
(13:27):
retreat into yourself. It's almost like you're watching a movie
of yourself as a way to kind of insulate your brain,
insulate your feelings so that you can sort of deal
with this unhealthy situation around you. But the thing is,
researchers are saying that trauma survivors heroin use might actually
be an attempt to reduce the earlier trauma's effects. And
(13:51):
this is what they refer to as chemical dissociation versus
the psychological dissociation that you know you will see children
and abuse of homes experience, and when it comes to adults,
if you've never learned to deal with your trauma, or
you know, face difficult situations head on and overcome your
habit for lack of a better word, of dissociating from
(14:14):
traumatic experiences, you might just continue to dissociate and that
could potentially lead to multiple personality disorders. But it's all
very wrapped up in trauma and then in heroin useed
so is this U fancier term for self medication. Yeah, basically,
(14:34):
especially because it's also linked Heroin uses also linked to
things like anxiety and depressions. So there was this big
Illinois study from looking at heroin users in and around Chicago,
particularly actually the around parts, so a lot of them
were in the suburbs. Uh, And they found that more
than seventy of the sample self reported or exhibited symptoms
(14:57):
of mental health disorders like anxiety, depression, bipolar disorder, and
a d H d UH. And they found that women
were actually slightly more likely to have a co occurring disorder.
But the majority of the participants in that study said
that heroin youth provided them relief from their worries and
(15:17):
anxieties because heroin when you use it, when you use it,
it provides both pain relief but also detachment from emotions,
so it provides that chemical dissociation that those other researchers
were talking to. And many of the people in that
study also exhibited sensation seeking behaviors to and that's a
point that we'll revisit later when we're talking about heroin's
(15:41):
explosion in more rural settings. So if we look at
this epidemic of heroin youth sets happening right now and
how it relates to the so called war on drugs. Um,
we see some changes in how it's portrayed, kind of
who is representative of that, and also how it's being approached. So,
(16:05):
first of all, the rise of heroin has been tied
directly to the use of and more specifically, the crackdown
on prescription painkillers, particularly OxyContin. UH of recent heroin users
say that they switched to heroin after first trying prescription
pain killers, and uh, anecdotally, I was talking to a
(16:29):
friend about this episode that we were about to come
in and record, and she was saying, oh, absolutely. A
family member of hers um started taking pills when he
was in high school, and he came from a very
affluent family, went to a nice school, and very quickly
(16:50):
the kids he was hanging out with were like, oh,
you know what, these pain killers are fine, but have
you ever tried heroin. It's actually cheaper, and you know,
you start sorting it and then next thing you know,
he's in and out of rehab. Yeah, there's I mean
not to like spoil the rest of the episode or anything,
but I mean there's a whole lot of like class
(17:12):
access issues wrapped up in this because you know, it
is way more We don't have to tell you this.
I mean, it is way more quote unquote socially acceptable
to first take pain killers at all for anything, because
your doctor gives them to you, presumably you've got insurance.
You go to the doctor, you get your pain killers,
(17:33):
and then you just keep using them and it it
almost is like a fashionable thing. It's like going back
to Mommy's little helpers, you know, the the what is
it the Viking d or Vali vallium from the sixties
and seventies that the housewives were getting. Uh but at
some point when that becomes too expensive. But but it's
(17:55):
or if you're just chasing a different high. Yeah, like
it's okay to abuse pain pillars because a little harroin.
That's what poor people do. But as we're seeing like
all of these weird classes, assumptions about drug use and
abuse are definitely flying out the window. Oh, I wouldn't
say they're weird. I think more specifically, I was just racist.
So yeah, for sure, just racist. But this reminds me
(18:17):
of what I was telling you a couple of days ago,
when I was early in high school and I was
trying to impress a dude that I thought was cute
by talking about weed and smoking weed, and he was like,
you know, I'm really over that now and I was
(18:37):
like oh, and he was like, yeah, I'm just we're
into pills, and I you know, I was I think
sixteen maybe at the time, and just slowly backed away
because I was like, I don't you mean like i'd
be profound. I like, I don't why. I don't understand it,
but it's so so common and I'm talking to like
a middle class white dude. Yeah, I'm such like a
(19:00):
sheltered goody two shoes though, like hearing someone. If I
had heard someone say that to me, I would have
been like, but you don't know what it's going to
do to you. Oh. I thought the same thing. I
was like, why why would you do that? Um? And
I would so what if it's a blood cinner or diuretic.
I would like to report though, that both of these
guys that I've just referenced are like fully recovered and
(19:22):
they're both half away married and doing great, so good
for them. Not everybody is. Uh So, if we look
back at two thousand nine, uh, there were two hundred
and fifty seven million prescriptions for pain killers dispensed, and
that was up forty eight percent from just nine years earlier.
(19:45):
And in enough pain killers were prescribed to treat all
two d forty two million adult Americans around the clock
for a month. In other words, reading between the lines,
a lot of those pain killers were being averted to
illicit and illegal uses. Yeah. And when I first read
(20:06):
those statistics, UM, I was astonished first and then wondering,
how is it possible that so many pain killers are
being prescribed. I have a story. Oh well, a former
coworker of mine UM at a previous job, UM had
surgery and she was given pain killers to deal with
(20:28):
her surgery. And I'm not kidding you, dude, Like you
know you for anyone who's ever had surgery before, you
get a certain amount of pain killers and maybe you
can get them reapt like once if you're the pain
is really bad, or if you get infection or something
that needs pain killers. Um, she was calling like twice
a month, and her doctor was refilling it every time.
(20:53):
Pill mills total pill mills situation. She ended up getting
fired for abusing pain killers at work, and and she
was a middle class, middle aged white woman, and she
had health insurance, and she had health insurance well. And
we see though, all of this spiking, particularly in more
(21:15):
rural areas because, come to find out in the two thousands,
you know, doctors, uh, we're having trouble directly treating issues
in rural areas because they're more remote, and so they
would just write a bunch of prescriptions for pain killers
just cover up the pain. We especially if you're spread thin,
you know, you might be the only doctor in the
(21:36):
area for for for a long stretch, and so if
you're overworked, if your patients are complaining of chronic pain,
or if maybe you're just not a great doctor or
responsible doctor, that too. But yeah, so more and more though,
women have been the ones abusing pain killers in particular.
According to the cdc UH, men still overdose on prescription
(21:59):
pain killers more often, but the number of women who
are dying from prescription drug overdoses jumped four hundred percent
between compared to two for men, and that highest jump
for prescription drug overdose death was among women to fifty four.
(22:20):
By every day, eighteen women in this country were dying
from prescription drug overdoses and uh, you know the thing there,
in terms of going to your doctor, getting pain killers
and then developing an addiction, women are more likely to
suffer from chronic pain. They are more likely to then
(22:41):
be prescribed pain killers and for a longer amount of time,
and we tend to develop dependency issues faster, particularly not
only to opioids, but also to alcohol and marijuana thanks
to physiological differences that separate us from men folk. Basically
that we just hold on to those substances in our
systems longer. Just side note, I really appreciate your use
(23:04):
of men folks. Yeah, and it's like really serious discussion
the men folks men folk. But another key factor to
this puzzle is that the majority of overdoses happen when
those prescription pain killers are combined with other depressants like
alcohol or sedatives like ambient and xanax. You probably can
see where this is going because women are twice as
(23:25):
likely as men to have anxiety and seventy more likely
to have depression, which means they get more of those medications,
which means if they are also taking pain killers, they
are more likely to experience dangerous drag interactions. And throughout
all of this research I kept thinking about Amy Winehouse
and watching the Amy documentary, which I do highly recommend
(23:47):
if you're whether or not you're a wine House fan, um,
because her official cause of death was alcohol. But like this,
the majority of ODIs are happening because you are xing things.
Obviously she had had, you know, problems with heroin and
cocaine and like all sorts of other hard drugs as
well well, especially if you are building up that tolerance
(24:11):
because suddenly the amount that you're using is so much
higher than what you started at, but you don't feel
as good, so to speak. And considering those physiological sex differences,
you know, with our tolerance being lower than men typically,
whether we're talking about booze or something like heroin. You know,
thinking about Amy Winehouse before she tied to me, she
(24:32):
was tiny. She was already like a small woman, but
she was just skin and bump. Yeah, And you know,
we we've focused this this episode is focusing mainly on
on women versus men, but we also have to talk
about l g B t Q folks. They are nine
and a half times likelier to use heroin than straight
men and women, and a lot of that relates back
(24:55):
to all those mental health co occurring conditions we talked
about earlier, anxiety and depression, things that stem from the
daily exposure to homophobia, discrimination, the threat of violence. It's
just one more thing that that community has to deal with.
So as issues of you know, this painkiller addiction epidemic
(25:17):
started to rise on regulators radars, you have the crackdown
on OxyContin, so the manufacturer has reformulated it to try
to make it less habit forming um. And what happens
is that if you now try to crush it up,
it turns into a gummy substance, and that is to
(25:40):
discourage people from being able to snort it. But there
was a story on NPR not too long ago. They
did a whole series on the heroine epidemic and they
were shadowing woman who had the new oxycont pills. And
they've already figured out a way around, you know, the
(26:00):
the gummy stuff. I think that they now just uh
burn it, oh, you know, then smoke it. Yeah. So well,
because of those changes to the drug that make it
more difficult to abuse, you see black market pharmaceuticals price spiking,
(26:21):
and basically right after that, you see cartels moving into
more rural areas suburban and rural areas from places like
New York because suddenly there's a new market for heroin
and it's a wider and more diverse market than ever before.
So that's where you get this explosion. In these majority
(26:41):
white rural areas. They typically have police forces that are
spread way too thin. Um And like Vermont and New
Hampshire are kind of leading the way in this unfortunately.
Um And it was in an article in Rolling Stone
that we were reading about this explosion in Vermont that
(27:01):
cited one gay man who was, like, dude, it is
so boring up here, Like I have no social life,
no sex life, nothing. And that's not to like pin
anything on on gay men, you know, certainly not. But
there's that goes back to that whole sensation seeking attribute
that we mentioned earlier that whether you are gay, straight, whatever,
(27:24):
if you feel isolated and are looking for some change
for change's sake, a lot of people are turning to
drug use. I mean, and that's that's not surprising to hear.
I mean, I think that you see that in smaller towns,
even if we're just talking about alcohol. You know, it's
like the image of what are we gonna do. Let's
(27:45):
just hang out on the Walmart parking lot and drink
some for days. You know, boredom You telling me about
your childhood condor. Uh, it was cobra malt liquor and
peach snaps and a cul de sac and not the
Walmart parking lot. But yes, a little bit. That's like
a country song. Well, we were in a relatively country town, Caroline.
(28:06):
But this is something echoed by Matthew Birmingham, who is
commander of the Vermont Drug Task Force, saying I think
he was speaking to rolling Stones, saying that listen, especially
when we're young, there's that feeling of being removed from
the world and there's a lack of you know, feeling
like they're going to be consequences to what you're doing.
You're almost invincible. Yeah, there is that that kittitude. Kittitude,
(28:30):
lose the kittitude sometimes I need a little more kittitude.
I know there's a balance, definitely. Yeah. And Birmingham's statement
was echoed by Jesse Farnsworth, who works at the Howard Center,
an organization that runs treatment clinics in Vermont, and Jesse
just said that you know, kids today don't feel like
they're a part of anything. And when people feel isolated,
(28:51):
it's easy to want an escape from reality. I mean,
that's not saying that any person who feels isolated, bored,
or whatever is going to immediately turn to heroin. But
when you do have this explosion of heroin alongside people
who perhaps are already using painkillers or perhaps seeking a
new experience, that's like, that's a terrible combination of opportunity.
(29:13):
And now that we have sort of laid out the
general landscape of what's happening with the heroine epidemic, particularly
in the United States and international, listeners really interested to
hear from you on this in Canada, that includes you. Um,
but we're gonna take a quick break and come back
and spend the rest of the episode really focusing on
(29:35):
heroin as it relates to women. So, in the nineteen fifties,
women made up just of haroin users, but now we
(29:57):
are a majority, we make up more more than Yeah,
that's a that's a gender gap that didn't need to
be closed, I know. Uh. And if you're looking at
the average first time heroin user, that person is most
likely a twenty three year old white woman. According to
the Journal of the American Medical Association psychiatry. And Uh,
(30:21):
one fact that I hadn't really thought of that came
up in that Rolling Stone article about the heroin epidemic
is that, you know, you have all these cartels and
drug dealers moving into more suburban and rural areas from
cities because they have all of these new markets that
aren't really being policed maybe as strongly as some of
the urban markets. And they're recruiting a lot of these
(30:43):
average twenty three year old, fresh faced white ladies to
traffic a lot of their drugs because like because white privilege,
I don't know, because police are less likely to look
at some um white girl and be like, oh, you
must be trafficking heroin in your car, speaking of traffic.
Doesn't the movie Traffic also have a plot line where
(31:05):
it's the fresh faced, blonde white girl who is addicted
to heroin. Oh, I don't know, I've never seen it. Finally,
a movie you've seen that I've seen that you haven't.
I know, Listeners isn't such a rare occurrence. Oh wow, Uh,
it might not even be traffic, But I know there's
a movie where that is the case. Um, and it
(31:28):
seems like too. When we read about these white young women,
it's also implied that they are cis gender and usually
straight white young women as well. And I think that's
part of the reason why people are so concerned about this,
because it's like, oh, well, if if these these women
are doing it, then it must be a problem. Yeah.
(31:48):
I mean the other side of that too, is that,
as that article pointed out, you know, because the heroin
abuse epidemic is now aligning itself with what used to
be the prescription painkiller epidemic. You know, you've got a
lot of folks with disposable incomes who can afford to
head off to rehab or can continue to get high
(32:10):
without needing to resort to crime to get money to
score their next batch of heroin. Or on the flip
side of that, if your forty dollar a pill uh
oxycotton or vicodin or percoset, whatever is costing you too much,
guess what's cheaper now, you know, heroin. So it's become
(32:30):
a last resort for people who we're hooked on painkillers
but need something cheaper and more accessible but equally strong,
if not stronger, So they go for heroin. Yeah, but
but it's gonna be laced with stuff you guys, and
I'm gonna get in your brain. I uh, please don't
your heroin. Um. But but women are more likely to
(32:52):
be introduced to heroin injection, in particular by a sexual partner, uh,
and more likely to report feeling social pressure as a
result of it to the National Institutes of Health. And
that is what made me think of Amy Winehouse with
her Her ex husband, Blake has now publicly said that
Amy Winehouse first said heroin, you know, under his influence
(33:15):
because he did it first, and then they became a
heroin addicts together. He claims that they were shooting up
regularly for only, in quotes four months, and that she
was actually worse when he was in jail. But if
anyone who knows anything about Amy Winehouse and Blake Fielder
civil is that his last name, uh knows that you
(33:36):
can trust what Blake says about as far as you
can throw him. Ditto her father. But of course this
isn't just a factor for celebrity couples. I mean, this
is still the whole the whole issue of it being
something that happens in sexual relationships is a pretty common hallmark,
especially when we're talking about women in heroin. Yeah, and
(33:57):
when we are talking about women in heroine, we tended
it and smaller doses, which could explain why men are
still four times as likely to die from a heroin
overdose the women are um And Earlier studies, also, like
from the drew some distinctions about how women use it.
Uh So, not only you know, are we likely to
get it from a sexual or romantic partner who's also
a drug user, but women are more likely to share
(34:19):
needles and received previously used injection equipment. And that's obviously
a major red flag for the spread of disease. But
going back to that International Journal of Drug Policy study,
there was something there was an attribute of this of
heroin use and abuse and dependency and recovery that I
had not considered at all before, which is social pressures
(34:41):
around appearance. So they found that both men and women
tended to ignore personal appearance issues during those periods of
heavy use. But regardless, women still remained more concerned about
appearance both during use and during recovery. And there was
this big concern that as soon as they stopped using
(35:03):
and they're gaining that healthy weight back that they had
lost when they were abusing drugs that they were going
to look fat, and so then you have the added
layer on top of struggling in recovery, you've got the
add a layer of eating disorders that tend to surface
among people who are afraid of getting fat. First is
the men who tended to like the added weight. They
(35:23):
were like, yeah, I'm getting compliments on how healthy I look,
so I must be getting better. So that's the weight game.
For men was an encouraging and supporting factor to getting better,
but for women it was almost discouraging. Well, and then
if we look at pregnant women, no surprise here that
heroin use is associated with low birth weight. UH. Infants
born dependent on heroin um babies can suffer from neonatal
(35:48):
abstinence syndrome, which is essentially when babies are born going
through drug withdrawal and so they're crying constantly and are
just in physical pain. Yeah, And the thing is, like,
speaking of the nineties, it really wasn't until around the
nineties that women's addiction issues in general got specific attention,
(36:09):
and a woman centric push was super necessary because that
early addiction literature either ignored them or portrayed them as
weaken and secure or somehow sicker and more disturbed than
male addicts. And women, they found have specific hurdles to
support and treatment and getting recovery that include social stigma.
(36:32):
You you're a bad woman or a bad mother if
you let yourself get addicted to something. You've got issues
of childcare because hello, women are more likely to be
the ones responsible for it. So it's not like if
you've got three kids, but you're addicted to a substance,
including heroin, you know, maybe you feel you can't stop
everything and go to a center of some sort of
(36:53):
recovery facility. You've also got issues of transportation and unemployment.
You know, you might lose your job or be unable
to find a job when you're stopping everything to try
to get recovered. Yeah, I mean there there is that
gendered stigma on female drug abusers, um, whether it's heroin
(37:14):
or any kind of drug, because I think we do
still perceive, you know, female drug addicts as more deviant
than men. It's like violating all of those feminine norms.
Weren't we supposed to be the moral centers of society? Well,
and if anything, the stereotype is that you are a
Valley of the dolls, like Mother's Little Helper, uh, Viking
(37:36):
and valium user. You know, like it's okay to stay
at home and take your little pink happy pill. But
heroin that's that's like aggressive. Yeah, I mean I also, Yeah,
I feel like anytime you have drug abuse and motherhood combined,
the stigma is doubled and tripled. But unfortunately it's often
something that goes hand in hand. Yeah. And that International
(37:59):
Journal of Drug Policy study also pointed out the whole
thing with appearance and weight and drug using stigma. Uh,
all of that affects a woman's cultural capital, and that is,
as we were talking about, a potential hurdle to recovery. Uh.
They wrote that if society has more onerous expectations of
(38:20):
women than men in terms of their appearance, behaviors, or
carrying obligations to others, this is likely to place more
material and psychological demands on women in recovery. So basically, like,
don't forget to smile. I'm saying that as a stand
in for like, make sure that you're thin and pretty
and a good mother, and that you're healthy and that
you've got a job. All of these extra expectations like
(38:44):
don't forget to put on your lipstick. A plus side
when it comes to gender and drug abuse, though, is
that the same study we've been citing a lot found
that women do report more informal support, having an easier
time making non user friends, and are likelier to say
that their kids motivate them to kick the habit and
(39:07):
stay quean. Yeah, and there's actually, I mean, speaking of
women and kids, there's a great example of treatment coming
out of Iowa. It's this place called the Heart of Iowa.
It's a residential program for women with kids. UM. It
doesn't only treat heroin users. It treats women with a
variety of substance abuse issues. But it's been around for
(39:28):
like twenty years. UM. It was created in response to
a high percentage of women who were opting out of
residential treatment facilities because they didn't want to have to
abandon their children to foster care. UH. There are fewer
than twelve programs like this in Iowa, which means there's
a huge waiting list, which of course can complicate recovery. UM.
(39:48):
There are other programs that you have to be like
a certain amount pregnant, you have to be like a
certain amount into your pregnancy before they'll accept you. So
that like dead space ace of having to wait until
you're somehow pregnant enough to go into the facility can
also complicate recovery. But at this heart of Iowa Place,
(40:09):
I mean, the women have full days from eight thirty
to seven at night. Um, they have a comprehensive curriculum
where they can learn strategies for relapse prevention, even how
to quit smoking, but also how to budget and and
parenting skills. They can attend group therapy, individual counseling, and
the facility even has like an outreach branch that can
also reach the partners and or spouses of these women
(40:33):
in different facilities, so that there's a more holistic, whole
family approach to recovery. But I mean they also get
mental health counseling, life skills training, on site childcare, and
and most importantly those furnished on site apartments that let
the women have the dignity of a private space that
they can return to at night after the day is over. Yeah,
(40:55):
I mean this sounds like like the ideal situation for
an excessive bowl rehabilitation facility. I'm not not talking about
like a celebrityhab you know, bazillions of dollars kind of place.
But unfortunately, I mean, all of that relies so much
on how many you know, how much government funds are
available to make that happen, And a lot of times
(41:17):
the answer is there's there's not too much, especially as
the demand is increasing UM. And that leads us to
questions about medication for treatment. Because you have methodone, which
is probably the heroin treatment medication we're most familiar with UM.
There's also a newer one called bupren nor Fine. There's
(41:41):
also now trek zone that act on the same parts
of the brain that heroin does. But both methodone and
buprenorphine suppressed withdrawal symptoms and relief cravings. Now trek zone
blocks those opioid receptors. And if I'm recalling correctly, one
big prints between methodone, which can be addictive UM and
(42:04):
buprenorphine is that beauprenorphine does not UH, it blocks the
same like drug and reward pathways that methodone does. That
can lead to more addiction. Right, And there's questions too,
you know, when you talk about UM parents, women with
children of whether methodone and buprenorphine are safe for pregnant women,
(42:28):
and methodone is definitely still the preferred and recommended treatment,
although it is associated with that neonatal abstinate syndrome that
can affect newborns. And there was actually study that found
that compared with methodone, buprinorphine was actually better than methodone
in reducing those withdrawal symptoms in newborns. But a lot
(42:49):
of doctors are are uncomfortable using it just because it's
it hasn't been as extensively used in pregnant women, so
there's still some question. Um, you also have no locksone,
which is used as an emergency treatment to counteract the
effects of an o D, And there have been a
lot of articles and NPR segments, segments for instance, that
I've heard about police forces and outreach groups carrying shots
(43:14):
of alex and with them so if they encounter someone
on the street who is experiencing an overdose, they can
inject them with this rather than just either letting the
person die or shipping them off to jail immediately. Yeah,
so speaking of jail, I mean, this is such a
complicated issue when it comes to pregnant women. Um, pregnant
(43:36):
addicts in particular because you have states like Tennessee, which
became the first state to pass a law that would
punish drug addicted pregnant women. So pregnant women who take
narcotics can be charged with aggravated assault to their fetus.
But it has no targeted drug treatment programs for pregnant
(43:58):
women rather than treating the to you, you're just sending
them to jail, and that it's not going to solve
anything in NBR, We're gonna keep reverencing NPR. This episode
was brought to you essentially by like Morning Edition and Marketplace,
because I believe it was on Marketplace or either that
are all things considered. I forget because they come on
back to back every evening here in Atlanta. But they
(44:19):
did a whole heartbreaking but such important series on these
women who are become addicted to heroin. They become pregnant,
and they have to make this choice between going to
the doctor and then finding out that they are addicts
and then them being sent off to jail or trying
(44:43):
to manage their addiction through a pregnancy, and then of
course when they deliver, if they go deliver at a hospital,
they might be you know, risking being arrested as well. Yeah,
the article that we were reading about that Tennessee law
made the very important point that the states that punish
(45:04):
pregnant women who are addicted to drugs or alcohol tend
to be the states that lack any sort of supportive
treatment program for such women. It's not like, oh, well,
we're gonna try to treat you, and if you're still
abusing medications, then we'll send you to jail because we
tried our best. There's there's no try try harder. And again,
(45:26):
it's just punish the pregnant women for what they're doing
to their fetus. And since the heroin epidemic has been
so predominant among white people, you have more white middle
class families publicly raising their voices against tough war on
drugs policies, advocating for classifying heroindependence as a disease not
(45:50):
a crime, and they're lobbying state houses, holding rallies, and
starting nonprofits. And uh, it's quite a shift from what
a lot of white middle class families thought about tough
war on drugs policies when a lot of the people
being arrested were people of color. Yeah, oh, it's it's
(46:11):
a complete one eighty because now you're having more of
these white families losing family members to heroin, whether it
is death, an overdose, or whether it is going to prison.
The White House drugs are Michael Boticelli was very explicit.
He was like, Yeah, these people know how to call
(46:32):
a legislator, they know how to get angry with their
insurance company, they know how to advocate, and they have
been so instrumental in changing the conversation. And it's interesting
to see the effect these families are having in this
push to move heroin abuse away from being a crime
and more toward a disease. You know, we cited that
study out of Illinois at the top of the podcast.
(46:54):
It was actually I mean, yes, it was done by
a foundation, but it was actually funded by like parents
and grandparents. They helped fund this investigation into used and
abuse of heroin by suburban people. Uh, and you know,
they found all of these important aspects of it about
like young people who don't see the consequences of their
(47:16):
heroin use and abuse, about sensation seeking among young people
in suburban areas. And I mean, where was that for
the crack epidemic or really any other drugdemic. Including heroin
twenty years ago. Yeah. I mean that just throws all
of the classism and racism wrapped up in our drug
(47:36):
policies into stark relief. I mean, and and drugs are Botticelli.
He called it like he saw it. I mean, he
said quote because the demographics of people affected are more white,
more middle class. These are parents who are empowered. So
I mean, I absolutely support the concept of classifying heroin
(47:59):
dependence in other drug dependencies as diseases and treating them
as such. Um, and steering away from the criminality aspect
of just throwing them in prison and letting taxpayers pay
far more for imprisoning them than it costs to treat people. Um.
(48:19):
But I think we also have to take a step
back to and ask that question that you just did
of like, well, why are recently paying attention to this now?
And maybe we need to also, uh spread these resources
and all of this interest not only to white heroin
addicts in suburbia, but also to more inner city areas
(48:42):
that have drug problems but they don't have all of
those well funded grandparents who can somehow contact a foundation
and pay for a study. Yeah. And this is something
that Kimberly Williams Crenshaw brought up. She specializes in racial
issues at Columbia and U c l A Law schools.
She is also if you're like that name sounds familiar
(49:03):
to me as a seminty listener who's well educated and
curious about life. Uh cringe. Shaw also introduced intersectionality to
feminist theory. Hello, but she says this new turn to
a more compassionate view of those addicted to heroin is welcome,
but one cannot help notice that had this compassion existed
for African Americans caught up in addiction and the behaviors
(49:25):
that produces the devastating impact of mass incarceration upon entire
communities would never have happened. Oh yeah, I mean, like
there there are so many aspects of of privilege coming
up in this and and again it's not to say like, oh,
white people don't deserve any help for their drug addiction,
but it's like we've got to look at the whole system,
(49:46):
because the whole system is broken. UM. And how you
have a lot of these UM activist parents who have
lost children to hero and epidemics. UM. Even just paying
attention to language preferring to use words like addict in
lieu of junkie. Yeah. Yeah, well yeah, you know, and um,
(50:07):
I mean, one thing I want to say about all
of this too is um as it also kind of
relates to issues with STDs and her pies, things that
are really common but highly highly highly stigmatized because of
a lot of misunderstanding and silence around it. Heroin UM
doesn't necessarily connote homeless person, you know, prone to crime,
(50:33):
sitting on the corner. Yeah, as Yeah, most drugs don't
necessarily connote that, right, And we need to re you know,
and we need to collectively shift our mindsets away from
that because in a lot of ways, that is very
classics and prejudice. Because I have seen heroin. I've seen
it at a party with my own eyes and seen
people who are on heroin, and I have known people
(50:55):
who have gone to rehab for heroin UM and all
of those people I'm talking about our white middle class
and a lot of them college educated. Yeah, And I
mean I think, you know, we talk about the important
shifts that we need, and the demographic shift is behind
a lot of changing policies. I mean, you know, Vermont
(51:19):
heroin US is now so concentrated in that tiny state
of Vermont that their governor, Peter Shimlin, for instance, is
now expanding treatment programs and helping addicts get into those
programs instead of just sending them to prison. And these
are tactics that on the national level, people are starting
to take notice of and saying, oh, maybe we do
(51:42):
need to treat the root causes of addiction. We need
to focus our money and energy and effort on mental
health counseling and support. We need to understand mental health
and trauma better. We need to support people who have
been led to abuse substances rather than treating them as criminals,
(52:03):
because that doesn't really Throwing people into jail does not
fix any of these root causes. We zeero it in
on trauma early in the podcast because it's important to
talk about that because trauma doesn't only affect someone you know,
in a poor area of town. Trauma cuts across every
type of demographic and so as does the use of
(52:25):
multiple kinds of drugs, which is also a predictor for
heroin use. I mean, this is nothing that's exclusive to
one demographic. Yeah, I mean, and especially when it comes
to heroin and opiate addiction. Your chances for relapse are
so high that if we treat it, you know, solely
by tossing them in jail, you're gonna have a high
recidivism rate. You know, it's gonna happen. And I mean
(52:48):
treating it more as an addiction and a health issue
is going to be more cost effective overall for all
of us because these are our taxpayer dollars paying for it.
Because you have to remember that this is not an
individual problem, one person's, one woman's uh. Heroin addiction can
potentially be the spoken you know, a whole wheel of
(53:10):
issues such as sex, work and a s CDs and
childcare and on and on and on, and we're we're
a community here, we're all affected by this, and like
just stigmatizing this one group and saying like, oh, they're
just broken, horrible people. Just get them out of my sight.
Like just because we don't see them doesn't mean that
(53:32):
the problem goes away exactly. And that's why you see
like in places like Seattle, which I think is the
first to try this, maybe Vancouver also in Canada, but
the Seattle Mayor is actually backed opening safe consumption sites
for addicts, places where um, you can get clean needles
and supervision and anti O D medications UM. But basically,
(53:58):
you know, addiction and crim records can keep a lot
of addicts out of shelters and out of facilities and
things like that, UM, And so like, how is that
helping anyone? Because then you are likely to see the
domino effect of you know, staying on the streets, continuing
to uh, potentially use unsafe needles and practices, um, getting
(54:22):
jailed for your drug use and and the cycle just continues.
So it'll be interesting to see what the effects are
if if the Seattle Safe Consumption Site thing goes through well,
and that's also going to depend on what local communities
decide on because it might have been in West Virginia
or Vermont. This was something that came up in that
(54:43):
Rolling Stone article where a rehab facility specifically for heroine,
like a treatment center was going to open in the
small town where there had been a massive problem with heroin.
But the people living there like vetoed it because they're like,
we don't that here, we don't want those, you know,
just attracting more addicts. Was like there's a backwards I know,
(55:07):
and that's the stigma at work, and I I mean,
I want to hear from listeners about this because I'm
sure there are so many complexities to this issue, especially
when it comes to treatment UM that we haven't acknowledged UM.
So yeah, I mean, I just want to open this
(55:28):
up now to listeners this year. What you think, especially
because we have such a geographically diverse audience that we
probably have people listening right now who are in towns
in areas where heroin has become more of a problem UM,
or if you were in an area where you've had
a successful treatment systems set up, or if you just
(55:53):
know someone who's dealt with this. We want to hear
everything that you'd like to share with us. Mom Stuff
at how stuff works dot com is our email address.
You can also tweet us at mom Stuff podcast or
messages on Facebook. And we've got a couple of messages
to share with you right now. Okay, I have a
(56:14):
letter here from Sarah. She was writing into us in
response to our Libido Liberation episode where we talked to
Maria Finitzo, who's a filmmaker, UM, and she wants to
write us about the misconception about the Immaculate conception. And
Sarah was not the only person to write in about this,
so I definitely wanted to address this point that she made.
(56:38):
She said, I wanted to point out a mistake that
many people make with the term immaculate conception. Many people
believe that this refers to the sex reconception of Jesus
that preserves Mary's virginity. This would be the doctrine of incarnation. However,
the immaculate conception actually refers to the conception of Mary herself.
Mary was conceived by normal biological means by her parents,
(56:59):
but God made it so that she was free from
original sin because she would later become the mother of
Jesus Christ. In Catholic doctrine, original sin is something that
all men and women are born with as a result
of the disobedience of Adam and Eve and their fall
from Eden. Well, a big to do is made about
Mary being a virgin when she gives birth to Jesus.
The immaculate conception is a reference to her own purity
and elevation above all other mortal men and women. This
(57:22):
is what makes her worthy of being the mother of
Christ and upholding a very high place of reverence within
the Catholic Church. My mother was raised to strict Catholic.
While she no longer considers herself one, she still has
a strong respect for many of their philosophies. She was
the first person to point out to me that so
many people don't use the Immaculate Conception correctly. I find
theology fascinating and loved reading about this. After she corrected me,
(57:43):
keep up the good work. I look forward to diving
into your latest podcast about Lisa Frank, Oh Sarah, speaking
of Lisa Frank and then therefore speaking of unicorns, I
hope that you also find our conversation about unicorns and
Jesus and purity and ruginity interesting in that episode as well.
Oh man, Jesus and unicorns, what a combo? I have
(58:06):
a letter here from a Christian with a K about
our episode on exercise and breasts, subject line Army boobs.
She writes, I was in the Army for eight years
and always struggled with the classic Army activity of running.
It took about two years of running with massive groups
of people, primarily men, before I was alerted to what
(58:29):
was holding me back. One day after a rough run,
a senior ranking man came up to me and studies
life changing words listen. None of these other guys are
going to tell you this, but you need to know
your run sucks because you're cradling your boobs instead of
pumping your arms, and you don't even realize it. I
took a quick job to see if he was right,
and by golly, he was. I felt like I was
(58:51):
pumping my arms, but I was actually cradling my c
slash d cups with my forearms. I quickly went and
got myself some new, better fitting sports bra and my
runtime immediately improved. Huh, what do you know? And hey,
you know what red dude alert for, like talking to
a woman about her breasts in a respectful manner and
(59:12):
pulling her aside. Yeah, and not shaming her. Man. Well done, dude,
she says. I love you, ladies, and thanks for what
you're doing. Well, thanks for sharing that with us, Chris
sincas Um, I have a feeling that that might set
off a lightbulb in some other runners ears as they're
hearing this. And now I'm curious about my running form.
(59:34):
But if you have any tips to share with us
on running or just anything at all, Mom stuff at
how stuff works dot com is our email address and
for links to all of our social media as well
as all of our blogs, videos, and podcasts with our sources.
So you can learn more about women in the heroin epidemic,
head on over to Stuff Mom Never Told You dot com.
(59:58):
For more on this and thousands of other topics, visit
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