Dear Alice,

I'm thinking about trying heroin. However, this prospect makes me nervous because of all the media reports of people becoming so quickly addicted to it, wasting away, and even dying from overdoses. Any advice?

— Gathering info

Dear Gathering info,

Good alias... and smart strategy of getting informed before you try anything, especially a highly-addictive drug. Heroin, sometimes referred to as smack, horse, or hell dust, is an opioid, meaning it’s derived from opium poppy seeds. When injected, snorted, or smoked, heroin quickly converts to morphine and binds to opioid receptors in the brain that control pain, pleasure, heart rate, sleep, and respiration. This process can cause some to feel a sense of joy or euphoria. However, because of its highly addictive nature, it’s extremely hard to quit heroin. Heroin has ended the lives of actors, rock stars, business execs, homemakers, and college students alike — sometimes from overdose and other times from mixtures with other drugs. The latter cause is often unknown to users who buy their drugs from unfamiliar or dishonest sources.

Heroin usage has been increasing in the US over the past few years, irrespective of gender, age, or socioeconomic status, and along with this uptick in usage has come an exponential increase in heroin-linked overdoses. The situation has been referred to in the media as an opioid epidemic. The epidemic is thought to have begun with pharmaceutical companies pushing prescription opioids as pain killers, while claiming that they wouldn't lead to addictions. Health care providers began prescribing pain relievers such as oxycodone and other opioids more liberally, which resulted in many patients developing addictions. When they could no longer get prescriptions, turning to cheaper or more accessible alternatives such as… you guessed it — heroin.

When someone becomes dependent on heroin, their body craves more and more of the drug in order to reach the same high, making it easier to accidentally take a lethal dose when seeking out the euphoria they felt the last time. Further complicating the issue, it has become common for dealers to lace heroin with a drug called fentanyl, which is a synthetic opioid 50 to 100 times more potent than morphine. Fentanyl is a schedule II drug that is typically administered post-surgery or for intense pain and is often added to heroin without the knowledge of the user, which may make overdose even more likely. A fentanyl overdose typically results in slowed breathing followed by cardiac arrest, and it has been found that the administration of naloxone either injected or sprayed in the nostrils can reverse the overdose within a matter of minutes.

Before you decide whether to try heroin, you may want to think about the reasons you want to experiment. Are you trying to mentally escape from something? Are you trying to relieve stress? Alter your reality? Are you just curious? If your reasons for trying heroin have to do with wanting to change something about your life, or feel something different, you may want to consider talking with a mental health professional about these feelings and figuring out a non-addictive way of dealing with them. You might also consider finding other ways to relieve stress or to pique your curiosity that are lower risk and don't pose the same legal concerns.

If you're being pressured to try heroin by friends or peers, consider whether this is something you really want to do. If you're not ready to decide just yet and saying no is difficult right now, try delaying until you're ready to make a decision that's best for your health.

Keep pondering and gathering,

Alice!

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