My Experience in Treating Heroin Addiction

A draft of this post has been awaiting my full attention all week. The death of Philip Seymour Hoffman opened discussions about heroin addiction, a subject that had been borderline on taboo and misunderstood in many ways. I’m sure my mum, who reads my blog, must have probably jumped in fright upon reading the title of this post, but I just wanted to add my personal views on the matter from my experiences in treating patients with heroin addiction when I used to work in pharmacies.

Beforehand, I want to mention that the last film I watched with Hoffman was a couple of months ago, called A Late Quartet. It was a movie about a string quartet, life, illness, love and human relations. As I adore classical music, I thought the move was beautiful, plus it couldn’t sound better to my ears. For me it turned out special that the last film I saw with him before his death was A Late Quartet. I shall choose to remember Hoffman for his talent and for the joy he brought to the world through his films.

At the beginning of my career I moved to England and worked as a pharmacist in community pharmacy. At that time the system to treat drug addiction was set up in a way that there were certain clinics with doctors that prescribed the treatment, social workers to help, and the treatment would be dispensed in a pharmacy. The pharmacy I was assigned to had to dispense treatment a number of heroin addicts, as in 30 each day. I had way more than 30 over the years because there was always turnaround: some dropped out and some died.

Working in a pharmacy like that was sort of like being thrown into the deep end. I came out of university full of molecular knowledge, but no subject had ever prepared me for the social skills needed to deal with this. Due to the fact that these patients saw me daily, they trusted me to tell me their life stories and daily struggles. There is a Spanish saying that goes la confianza da asco. It can roughly be translated into trust is disgusting. All this trust meant that if they were having an especially bad day, us pharmacy staff would probably be the ones they would strike out against. My staff did press the panic button under the counter a few times.

For anyone that has ever been affected through a family member or friend, please excuse me for writing all this so bluntly, it’s just that these things happened quite often.

They would come everyday for their dose of methadone or buprenorphine, which are supposed to help them get weaned off the addiction. Most of them had it prescribed under the supervised consumption regime, meaning they have to consume it there while being watched by a pharmacist. The main reasons for supervised consumption were so that it’s harder for them to sell it as soon as they walk out, and also because most had children, so it prevents the children from trying it at home. If they see Mummy have it everyday, it’s must be a normal thing to do.

Now I want to write about some of the pharmacological aspects of heroin and opiates. Heroin is an opiate. Opiates are narcotic opiod alkaloids derived from the plant Papaver somniferum, the species within the poppy flower family that produces opium.

I’ve heard strange things about heroin, opium, opiates, and morphine this week, as if they were all the same thing. Mumble jumble. Heroin is an opiate. Not all opiates are heroin. They are not all morphine. Many opiates are used in medicine. Am I confusing you even more?

If opiates are narcotic, why are they used in medicine?

The well known effects of opiates are, well, the narcotic ones, giving a high and with highly addictive effects. But they can also produce other effects such as pain relief, slowing peristalsis and respiratory depression. The molecules that are derived from opiates, whether naturally or modified semi-synthetically, can be used to treat certain conditions due to these other effects. Plus, some of them have lower addictive powers, so they are easier to use. I’ll explain with some examples from the three effects I mentioned just now.

Pain relief: the ones that relieve pain are usually the more addictive ones. Codeine relieves pain. It can be found frequently in some pain relievers, combined with other more “normal” pain relievers (like with paracetamol). Morphine relieves pain big time. It can also cause addiction big time. So morphine would only be used in extreme circumstances of enormous pain and in terminally ill patients. Its use should be very controlled by the doctor.

Slowing peristalsis: this means that it slows down the movement of the intestines, making it a great treatment for diarrhoea. Again, codeine can be used but that’s found in older types of formulas. Loperamide is more widely used for this purpose because it has way lesser narcotic effects.

Respiratory depression: this means that it slows down your breathing system, making it useful to stop coughs. Again, codeine can be used and is limited to older formulas. Dextromethorphan is the one very commonlly used for this. It can make you feel quite floaty.

Main uses of opiates

I’m going to write about the side effects. They include making you sleepy. Though I hope all this pharmacology talk isn’t making you doze off…

So, if you are take an opiate to treat something, you can guess the common side effects due to these collateral effects: like making you sleepy, floaty and constipation. Naturally one must be very careful using these medicines as they can get you addicted. And with regards to slowing down breathing, here is where the greatest danger lies with any opiate drug: if there is an overdose, breathing stops. The person dies.

Caution

I’m making it pretty clear that we must be very careful whenever being treated with any opiate for any reason, so as to not overdose, and also to not get addicted.

How did my opiate addicted patients get into this tragic situation? Each and every case is unfortunate, bringing terrible despair to themselves and their families and friends. A minority began though medical treatment, maybe they had broken a leg or suffered a painful illness and were on morphine, then got addicted. Some people weren’t being treated for the addiction because they had not admitted it to themselves yet. But due to what they were buying, the pharmacy staff knew. Some had suffered tremendous problems in life, so began drug abuse in a desperate effort to forget. Unfortunately most had began out of sheer stupidity by trying heroin.

The thing that they all told me was that when it comes to heroin, it is extremely addictive. After trying it only once or twice, that was enough to get them totally addicted and ruin their lives. The one message they all wanted to get across is please never try heroin.

Thank you for reading!

28 Comments

  1. Guillermina Bósquez Stover 2014-02-10 at 02:46

    A very thorough clinical explanation of opiates, Sofia. Addiction is a disease, whether with alcohol or opiates…it is the rush that the addict wants. He or she is not concerned with the consequences, unfortunately. And the biggest consequence of all is death…or maybe they do want that, who really knows?

    Reply
    1. Sofia 2014-02-10 at 23:32

      I had many, many patients, and most were sort of “forced by law” (to call it something) to be under treatment. Very few actually were serious about stopping. Most, I perfectly knew, took more drugs even though they were on the treatment, So you’re right, it is the rush they want, they do not bother about the consequences.

      Reply
  2. Lily @ChloeAsh 2014-02-10 at 03:02

    Thank you for your unprejudiced sharing, Sofia. I think articles like this are a breath of fresh air, considering all the bashing that’s been going around. Well done 🙂

    Reply
    1. Sofia 2014-02-10 at 23:34

      Thanks Lily, after hearing and reading many things this past week (and plenty of things contradictory to my thoughts) I knew I had to publish this… even if only few people were going to read it, lol. xx

      Reply
  3. Dalo 2013 2014-02-10 at 04:10

    Your poor Mom, I think you were right though as I even did a double-take 🙂

    Addiction to drugs is something I cannot imagine, but every story seems tragic…it seems they all strive for more, success and feel the pressure of doing well, but once they have this taste/rush seemed doomed to a life of a constant battle. Enjoyed learning more about this from a clinical point of view…

    Reply
    1. Laura Lynn 2014-02-10 at 08:17

      So sad about Hoffman. I, too, have experienced heroin addiction at second hand and I lost my good friend to it. She left a little baby daughter behind her, who never knew her mom. I couldn’t stop Saundra, neither could her family. Not even the sight of her beautiful little daughter could. She was clean for almost a year. She stopped using when she got pregnant and within 6 months of giving birth she went right back to it. And it stole her life. I miss her to this day and if that didn’t illustrate the power of the addiction to me, then nothing would. I never did hard drugs and after seeing what they did to her, my heart goes out to all those lost in addiction. It must be terrible.

      Reply
      1. Sofia 2014-02-10 at 23:39

        Laura, yes you had told me about some of your experiences with this. I didn’t know she had a daughter, which is very sad, and I hope her daughter is growing up well.

        Reply
        1. Laura Lynn 2014-02-11 at 04:41

          I hope so too. I wasn’t able to stay in touch with the family after her death. They left town and who can blame them.

          Reply
    2. Sofia 2014-02-10 at 23:35

      My mum just wrote on my Facebook that she did not do a double take 🙂

      Reply
  4. Mabel Kwong 2014-02-10 at 10:23

    Addiction is a dangerous and miserable thing. It must have been hard for you working at the pharmacy in England and dispensing drugs that people became addicted to. A lot of people think that addiction is an individual problem, or a problem for the individual. If a person wants to wean themselves off something like heroin or even something as alcohol or caffeine, yes they can, but I reckon support from family and friends will get them over the line and help them become better people.

    Reply
    1. Sofia 2014-02-10 at 11:43

      Hi Mabel, fortunately most things in the pharmacy we have under control. I cannot imagine anyone getting addicted to loperamide because they have had a bout of diarrhoea, lol 🙂 Morphine is classified as a “controlled drug” so its not as if you give it out like doughnuts, there’s a lot of necessary bureaucracy around dispensing that, so that’s pretty much under control. I think the worst off is codeine which can be available over the counter and you know perfectly well who is buying it for what… I think that for someone wanting to wean themselves off heroin, it is such a strong thing (completely incomparable to caffeine) that yes, all the support from family and friends is important, but the most important thing is themselves wanting to get off it. To tell you the truth in all my years there, I think only 2 people really wanted to get off, and only they were successful.

      Reply
      1. Mabel Kwong 2014-02-13 at 12:01

        Codeine…cough medicine. No matter how bad cough mixture tastes, I always have this urge to down more than a spoonful of it (some taste quite good in my opinion). Maybe it’s the sweetness within it, I don’t know. Addiction is a very difficult thing, getting off addiction to something is probably a more difficult thing, but anything is possible if you put your mind to it 🙂

        Reply
  5. Sunny 2014-02-10 at 11:44

    Hey Sofia, I didn’t know you had first-hand experience dealing with heroin addicts. I feel so, so bad for Hoffman. It was another case of gone-too-soon. I’ve heard many different aspects of addiction, and the limited knowledge I have told me heroin is really the worst. I also heard that some people just don’t have the genetic barrier to addiction, and that’s why they fall faster. I think it’s a bit like psychological disorders though. Outsiders never really know what they are going through. The “closest” experience I’ve had with drugs was when people in the next lab of Dr. D got arrested because they were selling drugs. That ended the academic career of a post-doc student and almost ended it for a PhD student. I guess people just have to know that there is nothing glamorous about it.

    Reply
    1. Sofia 2014-02-10 at 14:58

      Oh yeah I’ve also heard cases of chemists in academy in trouble for that.. All this is exactly how you say: nothing glamorous about it.

      Reply
  6. Joyce 2014-02-11 at 20:32

    Thank you for posting this, Sofia. While I don’t have experience with heroin addiction, I have had friends and family members with substance abuse and addiction issues. My feelings teeter between anger, frustration, and empathy.

    It does always amaze me, the commentary that follows an addiction-related death such as PSH. There is such a lack of empathy and truly a lack of understanding about addiction. Once a person becomes addicted, its not exactly a choice.

    Reply
    1. Sofia 2014-02-11 at 20:50

      Hi Joyce, you’re right, one has a choice before being addicted (anger), but once already addicted there is not exactly a choice (empathy). It was very terrible and sad to watch how they degraded in so little time. Thats why I felt I needed to write this post – even if it won’t get read much.

      Reply
    1. Sofia 2014-02-12 at 16:32

      The years there were also fascinating experience!

      Reply
  7. laurasmess 2014-02-14 at 03:39

    I did a double take myself after reading the title of this post! But you’ve written your insights so well. I was also contemplating upon the danger of opiates after reading about Phillip Seymour-Hoffman’s death. Such a sad circumstance. I also work in health (social worker) so I’ve seen the gradual impact of these drugs on many lives also. There are many valuable therapeutic benefits but the addictive quality of opiates and benzodiazepines is so destructive. Ah, you’ll have me contemplating all day now! x

    Reply
    1. Sofia 2014-02-15 at 00:42

      I knew form the way you write that you have such a heart and must surely work in something that helps other people. You’re right, many of the side effects of these drugs, benzodiazepines included are so destructive. The aim of my post was to cause some contemplation 😉

      Reply
  8. Tala Ghalayini 2014-02-27 at 13:31

    during my internship, part of my clinical dietetic rotation was the psychology ward. many of the patients there were recovering addicts with underlying nutritional deficiencies. It was always painful working with them, without understanding the why and how of it. Thank you writing this, it cleared a lot for me. Xxx

    Reply
    1. Sofia // Papaya Pieces 2014-02-27 at 13:36

      For me it was hard to as (just like I wrote) i had pharmaceutical knowledge but on a human social level sometimes wasn’t sure what to do, so I know what you mean. I’m glad you read this one xx

      Reply
  9. The Mad Hooligan Chronicles 2014-03-05 at 14:27

    Thank you for the wonderful post. I have known a few people who’ve struggled with addiction (although not with heroin). I can’t even fathom how you dealt with your customers. It must take a special kind of patience. Ellie

    Reply
  10. Ashmina 2015-04-19 at 21:45

    Hello Sofia! I am working on my dissertation project for my Criminology degree. My topics on the impact of drug users such as heroin addicts on Boots pharmacists which are community pharmacies!! You described many things here that my participants in the research have expressed and I really want to use this as a piece of literature on my dissertation!! Thank you soo much for such an article!!

    Reply
    1. Sofia 2015-04-19 at 21:58

      Hi Ashmina! How exciting for you working on your dissertation, and on such an interesting topic. Please go ahead and do not hesitate to use this for literature, what an honour. Wishing you the best of luck x

      Reply

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