No Blame, No Shame: Treating Heroin Addiction As A Chronic Condition

Ever heard of a diabetic patient who ate a large muffin before having a blood glucose test, was scolded for giving in to temptation, and then told to just say no to carbs?

How about a cardiac patient who has a worrisome stress test and is shown the door when she admits to eating a few Big Macs?

That kind of response is all too familiar for patients whose brains have been altered by heroin or other opiates.

“We blame patients for their disease,” says Dr. Sarah Wakeman. “We also kick people out of treatment for having symptoms of their disease with addiction, which would honestly be malpractice if we did that with other conditions.”

Wakeman runs the Substance Use Disorders Initiative at Massachusetts General Hospital, where treating addiction as a chronic condition, like diabetes or asthma or high blood pressure, is the norm.

Patients are screened using questions that determine if they are at risk for addiction. There’s an assessment. Then Wakeman and her patients work on lifestyle changes, decide what medication will help break the addiction, and meet frequently to monitor progress. Continue reading


Addiction Expert Discusses Statewide Surge In Heroin Overdoses

An educational pamphlet and samples of naloxone, a drug used to counter the effects of opiate overdose, are displayed at a fire station in Taunton. (Elise Amendola/AP)

An educational pamphlet and samples of naloxone, a drug used to counter the effects of opiate overdose, are displayed at a fire station in Taunton. (Elise Amendola/AP)

State Police are trying to understand a surge of heroin and opioid overdoses. Authorities tell the Boston Globe that 114 people died of suspected opioid overdoses last month across the state — double the number in November.

That number also doesn’t include the state’s three biggest cities: Boston, Worcester and Springfield.

Dr. Daniel Alford, who oversees the clinical addiction research and education unit at Boston Medical Center, joins Morning Edition to discuss this statewide rise in suspected heroin deaths.

To hear the full interview, click on the audio player above.

Interview Highlights:

On why the heroin is so deadly:

DA: “I think we’re learning a lot from our patients who are seeking addiction treatment. They certainly have talked about a difference in appearance of the heroin that they’re seeing — there seem to be more crystals. It’s being cut with something, and whether it’s fentanyl or, some people have talked about methamphetamine, it seems that it’s being cut with things that are potentially very lethal.”

“I saw a patient just the other day who talked about the heroin now causing them to pass out within minutes of taking it, so they’re very nervous about using dealers that they’ve never dealt with before. And it’s really an opportunity to start talking to patients about overdose risk and making sure they have Narcan available and that they are not using alone.”

On whether restrictions on prescriptions are causing people to turn to heroin:

DA: “As you make one drug less available there is a tendency to start using other drugs, and heroin is certainly readily available, cheap and quite pure.”

On how doctors aim to scale back on issuing pain prescriptions:

DA: “As we start to decrease the amount of prescribing that’s being done, we clearly don’t want to decrease access to these medications to those who benefit from them because of their chronic pain, but clearly we need to be more careful and safer and there is a lot of educational programs that are ongoing to train prescribers how to prescribe these more safely.”


The Heroin Wars: Drug Use Surges In East — And Beyond

The New York Times reports that heroin use is surging in small towns and cities around New England, driven in part by restrictions on doctors prescribing painkillers (and pill that are harder to crush and snort) coupled with relatively easy access to cheap heroin:

From quaint fishing villages on the Maine coast to the interior of the Great North Woods extending across Maine, New Hampshire and Vermont, officials report a sharp rise in the availability of the crystalline powder and in overdoses and deaths attributed to it. “It’s easier to get heroin in some of these places than it is to get a UPS delivery,” said Dr. Mark Publicker, an addiction specialist here…Heroin killed 21 people in Maine last year, three times as many as in 2011, according to the state’s Office of Substance Abuse and Mental Health Services. New Hampshire recorded 40 deaths from heroin overdoses last year, up from just 7 a decade ago. In Vermont, the Health Department reported that 914 people were treated for heroin abuse last year, up from 654 the year before, an increase of almost 40 percent.



Heroin is all over the news these days, with the tragic death of 31-year-old “Glee” star Cory Monteith, who authorities say overdosed on heroin and alcohol.

And WBUR’s On Point aired an excellent segment yesterday on heroin’s “new reach,” including this riveting exchange between Rock Star Raven, a 32-year-old woman from New York who actually spoke with host Tom Ashbrook on her way to score some heroin. From the transcript:

RAVEN: I’ve worked at a bank for a while now and it doesn’t really discriminate. And it’s very, very difficult to stop and you can continue to be successful, to some degree, while continuing that lifestyle and it’s very difficult to get off. I agree Suboxone can be extremely helpful, however if you don’t continue using it responsibly you can continue your problem.
TOM: Raven, let me be very clear, you’re on the way to pick up heroin right now?
RAVEN: That is correct. Continue reading

Harvard Wife, Mother & Heroin Addict: A Survivor’s Story

Coonamessett Farm

By Dr. Annie Brewster

Anne grew up with privilege. She was well-educated, and she had resources. She married a Harvard professor. She sent her children to a prestigious private school. On the surface, her life looked neat and pretty, even enviable. But her life had another, hidden side.

For over forty years, Anne has struggled with drug and alcohol addiction, and for many of these years, while injecting amphetamines and heroin, her life was controlled by the need to find her next fix.

I knew Anne while growing up in the 1970’s and 80’s. She was my friend’s mom. I remember her as warm and open, striking in her mini-skirts and stylish boots. While she was certainly more Bohemian than my own mother, I had no clue that she was an addict. I never would have guessed at the suffering that was going on in my friend’s home.


Addiction is a disease with enormous financial and human costs: the National Institute of Drug Addiction estimates that substance abuse in the United States costs more than $600 billion annually. Addiction has been linked to increased incidence of cardiovascular disease, stroke, certain cancers, and mental illness. Intravenous drug use accounts for more than one-third of the new cases of HIV, and for the majority of cases of Hepatitis C, which can lead to liver cirrhosis, and in rare cases, liver cancer.


Anne, and her horse Tess, 2011

Medical research has only recently started to characterize addiction as a disease of the brain that preys on and alters the limbic system, the brain’s reward center. This has changed various approaches to treatment, and should also temper our judgement of the individuals who suffer from this condition.

Here, Anne, now 67, speaks about her long struggle with addiction. With tremendous courage, she talks about her pain, the pain she caused others, her numerous attempts to get sober and her many relapses. Anne has been sober for seven years now, a huge accomplishment. But her struggle continues because addiction is a chronic, lifelong disease.

(Dr. Annie Brewster is a Boston internist who became interested in storytelling as a way to promote healing among patients. You can hear more of her stories here, here and here, as part of our Listening To Patients series.)

Alcohol More Dangerous Than Heroin, Researchers Report

Alcohol does more damage to individuals and society than drugs like heroin, cocaine and ecstasy, a new study finds

NPR reports on a study published in the medical journal The Lancet online today that finds alcohol to be more dangerous than other drugs, including heroin, cocaine and ecstasy.

British experts evaluated substances including alcohol, cocaine, heroin, ecstasy and marijuana, ranking them based on how destructive they are to the individual who takes them and to society as a whole.

Heroin, crack cocaine and methamphetamine, or crystal meth, were the most lethal to individuals. When considering their wider social effects, alcohol, heroin and crack cocaine were the deadliest. But overall, alcohol outranked all other substances, followed by heroin and crack cocaine. Marijuana, ecstasy and LSD scored far lower.

Experts said alcohol scored so high because it is so widely used and has devastating consequences not only for drinkers but for those around them. When drunk in excess, alcohol damages nearly all organ systems. It is also connected to higher death rates and is involved in a greater percentage of crime than most other drugs, including heroin.