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Healthcare Journal of new orleans
I
JUL / AUG 2014
29
with pain the next time it hits. If, on the other
hand, a person finds out that they can take
a drug that makes the pain go away, they
do not go through this learning process. “I
don’t know the scientific basis for this,” she
relates, “but heroin addicts seema gentler lot,
who have a hard time getting into sobriety. I
would guess it is because the heroin is such
an amazing pain (psychic pain) reliever that
it is hard to go back to dealing with the world
in the raw. You have to learn about manag-
ing anxiety, frustration, loneliness, without
chemical relief. If you started using in your
late teens/twenties your emotional develop-
ment is arrested at that point and nowwhen
you give up the opiate you have to learn how
to handle all these emotions, have to grow.”
This is an important consideration when
thinking about drug treatment; to sustain
recovery, former addicts must not only
overcome the physical withdrawal from the
drug, but must also develop alternative cop-
ing mechanisms so they do not turn to the
drug the next time they find themselves in
a crisis. This is an especially difficult prob-
lem, because whatever coping techniques
are taught, they will probably be less effec-
tive than heroin, at least in the short term.
If an especially stressful event takes place—
not unlikely considering the circumstances
of recovering addicts—there is a tremendous
pull for former addicts to cope with the stress
by using heroin.
Clearly, heroin addiction is a complex
problem that goes far beyond the physi-
cal state of addiction. But, what if there is a
simple solution to the problem—rather than
trying to understand addicts and figure out
how to help them, why not just get all the
heroin off the streets? If there’s no heroin,
there can be no addicts. Setting aside the dif-
ficulty of actually accomplishing this, what
would happen if the entire heroin supply was
eliminated from the city?The research of Dr.
Eloise Dunlap and colleagues from the non-
profit think tank NDRI, Tulane University,
and the University of Houston sheds light
on this approach.
Katrina was a very unique event in that
it did something that no law enforcement
agency has ever accomplished: it com-
pletely wiped out a thriving drug market.
Almost overnight, the supply side of the
New Orleans drug market was completely
destroyed. However, demand for the drugs
remained. In response, suppliers fromHous-
ton stepped in to serve exiled New Orleans
users. New Orleanian suppliers, in turn,
regrouped and established new networks
to address the demand as well, and the drug
market quickly re-established itself, albeit
amid increased violence as the tumultuous
new “freelance” market was much more
chaotic than the established, more self-reg-
ulated “corporate”market that existed before
Katrina. Several studies of NewOrleans and
Houston drug markets, spanning the years
after Katrina, found that as long as pressure
was exerted in the formof demand for drugs,
suppliers stepped in to fill that demand. This
has sobering implications for supply side
drug solutions: the evidence indicates that
no matter what is done to smash the sup-
ply side of a drugmarket, if demand is there,
new drug markets will emerge to address
that demand.
Demand, then, must be the focus of a
successful public health program address-
ing the heroin epidemic. This is easier said
than done, even with drug users who have
been caught by law enforcement. Mandating
substance abuse treatment for drug offend-
ers has been notoriously unsuccessful, with
less than a quarter of drug offenders com-
pletingmandated drug treatment programs.
(As explained by Dr. J, coping with life’s dif-
ficulties is hard, especially if your life is in
ruins because of drug abuse; many convicted
drug offenders prefer to keep taking heroin
instead.)
There is, however, another justice-based
solution that addresses demand: “drug
courts.”Rather than sending users to prison,
they are put on probation, with regular drug
testing. The programs generally include drug
treatment, and some incorporate rewards for
successfully attaining treatment milestones
as well, but at the heart of the system is the
Short-term
effects of Heroin
Central
•Euphoria
•Alternately alert
and drowsy state
Mouth
•Dryness
Skin
•Warm
flushing
Respiratory
•Slowed
breathing
Muscular
•Weakness