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Texas Commission on Alcohol and Drug Abuse

National Institute on Drug Abuse

Dennis plays high school varsity football. When afternoon practice is over, he rushes off to snort heroin. Megan started sniffing at 14. "I’m not a junkie. I don’t use a needle," she tells her rehab counselor. Another teen says, "The biggest seller in town was a 15-year-old kid." A boy too young to drive complains, "The hardest thing about using heroin is getting a ride to my supplier."

Kids like these around the country are shattering the stereotype of America’s heroin users. From aging, inner-city dwellers to affluent, middle-class, suburban youth, heroin use is on the rise. The National Institute on Drug Abuse estimates the number of chronic heroin users at 810,000.

A significant increase also has been detected in heroin use among eighth- to 12th-graders. According to the U.S. Drug Enforcement Administration, the mean age of first heroin use fell from 27.4 in 1988 to 17.6 in 1997.

San Antonio reports heroin addicts as young as 12. About 10 percent of all people arrested in the area test positive for opiates.

Focus on teens

"Heroin use among Texas teens is increasing. Overdose deaths are up, and heroin now ranks third [after alcohol and crack cocaine] as the primary drug for which adults enter treatment," said Marianne Marcus, Ed.D., RN, FAAN, professor of addiction nursing at the University of Texas-Houston School of Nursing. "Mexican heroin comes into Texas and the price is lower and purity higher than in the past."

Increased purity makes heroin suitable for smoking and snorting, as well as injecting. Purity levels are as high as 55 percent in Houston and 65 percent in Dallas. The cost of heroin has plunged to between $10 and $20 for a capsule of black tar heroin. In the Dallas suburb of Plano, heroin overdoses and deaths have skyrocketed in recent years.

Most heroin in the Western states comes from Colombia or Mexico. Colombian heroin is typically white powder that’s snorted, smoked or injected. Mexico exports two kinds of crudely processed heroin to the United States – brown and black tar heroin – which looks like sticky black tar or a lump of coal. Both brown and black must be dissolved and diluted before injection. Liquefied heroin also is snorted using a nasal spray bottle, a practice called "shabanging."

Because heroin is so widely available, users consume more of it than in previous years. People who wouldn’t dream of using a needle begin smoking or snorting heroin. Pushers tell young people heroin isn’t addictive unless it’s injected, but many "sniffers" wind up injecting as their tolerance for heroin increases. Heroin is dangerously addictive however it’s administered.

Peer pressure encourages experimentation with heroin and other drugs. Teens report finding heroin for sale alongside Ecstasy at raves. Some adolescent girls use it for weight loss. Dealers try to get girls hooked on heroin so they’ll convince their older boyfriends to try it. Others provide free samples of heroin with the purchase of cocaine.

Medical consequences

Despite an increase in smoking and snorting of heroin, most of it still is injected. Consequences of heroin injection include bacterial endocarditis, abscesses, and the spread of hepatitis and HIV. Dirty needles cause 23 percent of new HIV/AIDS cases in Texas.

"We’re seeing two very different patterns of heroin use in Texas," said Jane Maxwell, Ph.D., chief of research with the Texas Commission on Alcohol and Drug Abuse. "First are the aging addicts who started injecting in the ’60s. They’re showing up with COPD [chronic obstructive pulmonary disease], cardiovascular diseases, HIV, hepatitis, and liver failure. The second group of users is younger, more affluent, and mainly smokes or snorts heroin. These new users are about one-third each Anglo, Hispanic and African American."

Nursing awareness

"Hospital-based nurses should be aware of the symptoms of heroin use," Marcus said. "Patients admitted for other reasons don’t always disclose drug use, and that may complicate the health problems that led to hospitalization. Signs of substance abuse may be masked by symptoms of the admitting diagnosis.

"Treatment options include medication and behavioral therapies," Marcus said. "A 1997 report by the National Institutes of Health recommended broader access to methadone maintenance and elimination of federal and state regulations that impede access."

A new, longer-acting form of methadone called LAMM (levo-alpha acetylmethadol) is showing promise, as is a medication that combines buprenorphine (Buprenex) and naloxone (Narcan). Recovering addicts report a significant decrease in craving for heroin with these medications.

Maxwell warns nurses, "Be aware of the threat of hepatitis and HIV, and always use universal precautions when indicated. Nurses must intervene aggressively and early with referrals to treatment. There’s a need for more education for nurses on substance abuse."