Thursday, May 24, 2012

Heroin "statistics"

I went to a school session on heroin use in the area. The bulk of the time was taken up with a movie in honor of a DeForest youth who OD'd last year. The movie wasn't very illuminating--I already know heroin was bad--but his mother (who made the movie) was there and I decided against complaining.

Heroin overdoses are rising, and so are associated deaths--the majority aged between 16-30 and most of those out of high school. They advertise a medication that, delivered promptly, cures an overdose, but there aren't many doctors qualified to "prescribe" it to a heroin buddy. Overdoses are pretty easy to measure: you count the hospital/morgue visits and add a factor from repeat requests for the Narcan. The ratio of overdoses to deaths was about 10:1 in Madison and Sun Prairie.

Not all their statistics were quite as trustworthy. They had numbers on Oxycontin abuse and other drug abuse in middle and high school that are apparently self-reported. Umm, I think I want a little more info.

Apparently Oxycontin is easy enough to get hold of that it makes a good gateway drug.

One other little number was dramatic by its absence: the ratio of users to overdosers. I trotted back and forth a bit online to try to get a ballpark estimate and it looks like of order 50-25:1. (Don't use that number anywhere, OK?) Which would make heroin use remarkably dangerous, so maybe I made a mistake. But if I didn't then that means 250-500 addicts in a town of 16,000. Apparently there are two aspects to habituation: the brain's changes to lead it to expect opiates, and the rest of the body's changes, in particular the respiratory system. The brain takes a year or more to clear itself, but the body recovers in a few days. Which means that after being on the wagon for a week, the same dose you took before could kill you. At least so they say.

The story arc was that middle and upper middle class youth were starting to abuse Oxycontin et al in school, but finding the supply limited, were migrating to heroin. The supply of heroin is greater, but it winds up costing a great deal. Upper middle class kids typically were preying on family and friends, and turning to dealing.

The numbers weren't quite consistent from slide to talk. At one point they were talking about doses for \$25, and another for \$150. A factor of 6 seems pretty large to be a habituation effect.

The state is into "harm reduction" and provides paper lunch bags with heroin kits, and encourages addicts to never shoot up alone. I wonder what the overall effect is. The harm for any given addict is presumably less, if he isn't sharing infected materials, but if the addiction rate rises it isn't instantly clear that we've reduce the harm. (I'd not expect the rate of addiction to rise immediately. Instead I'd expect a period in which the bags slowly grow more normal in the background, and then a rise.)

Simple googling didn't find me the sorts of n-tuples I like to work with, so I'll let this be a back-burner mystery for a while longer.

2 comments:

Assistant Village Idiot said...

Heroin addicts will sometimes go into short detox to reduce the amount they need to keep the addiction at bay, related to the phenomenon you describe.

I don't know the use to overdose numbers. From our angle we are more concerned whether the overdose on anything was an effort to get high, a suicide attempt, or some nihilistic attitude between the two.

james said...

Interesting. Probably not quite what the designers of detox expected.