Dissecting myths and realities about heroin addiction

Heroin addiction is one of the most stigmatised and misunderstood drug addictions, and this stigma is capable of causing great harm. As well as driving isolation in people struggling with heroin addiction, these attitudes have public policy ramifications. People with highly negative perceptions of heroin users are much less likely to agree with risk reduction policies, making them harder to implement. This means examining and deconstructing myths around heroin addiction is important.

We’re going to look at some of the most common myths about heroin addiction, where they came from, and the truth behind them.

Myth – heroin addiction is a choice or moral failing

 

One of the most pervasive and stigmatising myths about heroin addiction is that the person chose to become addicted and they are at fault for their addiction.

 

While it’s important to recognise the autonomy of people struggling with addiction – as it is by cultivating this autonomy that they can gain the strength and tools to fight their addiction – there are many reasons why someone can get addicted. 

 

For instance, 40-60% of a person’s risk of developing addiction is genetic, which an individual can do nothing about. Childhood trauma, having a family member with an addiction, environmental stressors and mental health problems all increase the risk of addiction. While factors such as trauma and co-existing mental health problems can be worked on, especially in the context of addiction treatment, this is a difficult process – and the presence of these risk factors is not the fault of the individual.

 

Assigning fault to the person addicted to heroin is unfair and counter-productive: the shame and stigma that arises from this can contribute to heroin users increasingly isolating themselves in their addiction, not seeking help and relying on heroin for comfort.

Myth – heroin is a young person’s problem

 

Heroin use has fallen among young people, and the average age of a heroin user is now 43. After a surge in heroin use in the 80s and 90s, use in young people has dropped, and many of the people using heroin now are older.

 

While it’s encouraging that heroin use has dropped among young people, it’s important that the people who have been struggling with heroin for a significant period of time get the support and care they need.

Myth – you only need to use heroin once to get addicted

 

4.1 million Americans over the age of 11 have tried heroin at least once – and it’s estimated that 23% of them go on to become addicted to heroin. This is a significant number, but it isn’t the majority. This shows that while heroin does carry a significant risk of addiction, taking it once is not a sentence for a lifetime of dependence. In fact, heroin addiction is progressive – and early intervention can significantly reduce the risk of heroin addiction worsening.

Myth: Heroin addicts must hit rock bottom before they can get better.

 

The idea that hitting rock bottom is necessary before recovery is possible is dangerous, untrue, and actively harmful. It can cause people to unnecessarily put off asking for help until they have reached their lowest – when, in reality, they could have benefited from help much earlier. 

 

The rock bottom myth can be traced back to one of the foundational texts of Alcoholics Anonymous, ‘12 Steps and 12 Traditions’. While AA has helped people all around the world beat their addictions, this myth is extremely unhelpful.

 

The right time to seek help for heroin addiction is as soon as you feel that you need help. In fact, having external support networks, like jobs and close relationships, which heroin addiction can damage, is extremely helpful in addiction recovery. Advocating the idea that a person must lose these ties before they’re able to engage with the process of recovery is a particularly pernicious myth.

 

Myth: Heroin addiction only affects certain types of people.

 

The risk factors for developing an addiction are numerous and complex. While some circumstances increase the risk of heroin addiction, it can affect anyone. A risk factor is a factor that makes developing an addiction more likely – it doesn’t guarantee it. Conversely, not having any risk factors – or only having one or two – does not make a person immune to addiction.

 

The idea that heroin addiction only affects certain people can be seen as a way of othering people struggling with heroin addiction – it only affects ‘those’ people, who the general public doesn’t need to concern themselves with. But heroin addiction can happen to anyone – and if it does happen, they deserve empathy and support to beat their addiction, no matter who they are.

 

Myth  – snorting or smoking heroin is safer than injecting it

 

It is understandable why people believe it’s safer to smoke or snort heroin. Often, a person may start taking heroin by snorting or smoking it, then move on to injecting it. This is due to bioavailability. Inhaling heroin, via smoking or snorting, gets about half of the heroin in the dose into systemic circulation of the body. Injection gets all of the heroin into the person’s system. One of the earliest symptoms of heroin addiction is needing more heroin to obtain the same high, and this means smoking and snorting become less cost-effective as the person’s tolerance increases. Injecting then becomes necessary to both reduce the cost of the habit and get more heroin into the person’s system.

 

However, smoking, snorting and injecting all have different health risks. For instance, smoking heroin is associated with CTD leukoencephalopathy – damaged white matter in the brain. This disorder can cause motor, cognitive and speech impairment, weakness, and even death.

 

While not injecting heroin reduces the risk of blood-borne illnesses, and is historically associated with lower rates of overdose, smoking and snorting is extremely hard on the respiratory tract and lungs. Nevertheless, there have even been some harm reduction strategies that have focused on trying to get users to switch from injecting to smoking. However, this may change soon – in the US, smoking drugs is now associated with more overdoses than injecting drugs.

Myth – medications for addiction to heroin, such as methadone, are just replacing one addiction with another.

 

This myth arises from the fact that methadone and other medications for heroin addiction are often also opioids, and this gives rise to the idea that by taking them you are simply switching one addiction for another. To address this myth, it’s important to examine heroin and medications such as methadone within the contexts they are taken in.

 

Methadone can be prescribed long-term (substitution therapy) or in detox. Taking methadone as prescribed in the context of medically assisted therapy is extremely different to taking heroin in the context of addiction. Methadone is prescribed and supervised, and the goal of methadone prescription in addiction treatment is to reduce cravings and lessen the impact of withdrawal from heroin. These medications provide relief from withdrawal without the high, and enable the person to engage in treatment.

 

These medications for heroin addiction treatment have a purpose, a goal, and an end date that can be worked towards. They are tools that help with the detoxification and rehabilitation process – they are not simply trading one addiction for another.