Heroin: Our Next Major Battle?

Article published in Indian Country Today.

For a decade, heroin use has been declining across the United States, and particularly in Indian Country. The Indian Country Drug Threat Assessment of 2008 showed 15 percent less heroin use than in 2000, and a proportional drop in the number of heroin-related crimes or people seeking treatment on reservations. But troubling new numbers, released in August by the Justice department and statewide drug enforcement programs show that heroin use may be on the rise again, threatening community well-being, public health and law enforcement resources.

Mexican drug cartels have been producing heroin in record quantities, and both black tar and brown powder heroin have flooded U.S. markets. Because of its prevalence and low price, heroin is replacing both cocaine and prescription drugs for some users.

We monitor dangerous drug trends. Our training clients and relatives are telling us they are starting to see an increase in heroin use in our tribal communities. Vigilance is key. These drugs will greatly impact the quality of life, health, and safety of our communities.

For over 6 years we have been sounding the alarm that prescription drug diversion has been a growing problem in Indian Country and designed training specific to its abuse in our tribal communities. As prescription drug monitoring programs and other proactive efforts are reducing the availability of prescription drugs, particularly opiate based drugs such as OxyContin and Vicodin, we now believe the return of heroin is imminent.

In Indian Country and nationwide, the problem of prescription drug abuse has opened the door to heroin. Researchers at Drexel recently released a study showing that about 80 percent of people who abuse heroin started with prescription painkillers in their teens, and drifted into injecting heroin within two years. Oxycodone (as in OxyContin or Percocet) and heroin are chemically indistinguishable, except that heroin is often impure or prepared with unknown quantities of ingredients.

As heroin floods across the Mexican border and through the heartland en route to large cities, communities in its path–including in Indian Country–suffer increased addiction, overdoses, and deaths. Since the 2008 Drug Threat Assessment, deaths from overdoses have increased 7%, resulting in the highest overall numbers of heroin deaths since 2000. Overdoses have rocketed in 60 U.S. counties in 30 states, particularly impacting tribal members in California, New Mexico, Oregon, Washington and Wisconsin. Heroin addiction is now the leading reason for seeking drug-related treatment at publicly funded facilities.

Some of the deaths and overdoses can be attributed to prescription drug abusers, who are attracted by heroin’s availability and low price. Like new heroin users, prescription painkiller addicts frequently overdose on heroin because they are unfamiliar with their tolerance levels, or because the heroin itself is impure. Not only is the Mexican brown powdered heroin more potent than pharmaceuticals; it can be more potent than previously available kinds of heroin. Dealers often mix the powder with potent Asian or black tar heroin or pharmaceutical opiates, with unpredictable results.

Serious health risks among heroin abusers injecting the drug also come from infections and diseases, namely HIV and AIDS, hepatitis B and C, tuberculosis, sexually transmitted diseases, and other viral or bacterial infections from sharing unclean injection equipment. Many of these ailments are sexually transmitted or otherwise communicable, affecting non-users as well. Alarmingly, many prescription drug abusers in tribal communities are accustomed to injecting drugs using needles from diabetic patients.

Property crime and gang violence are two other ills that accompany increased heroin trafficking in Indian Country. Property crimes attributable to heroin use have increased to about 20% of all drug-related crimes nationwide. National gangs on Southwest and Great Lakes reservations, like 18th Street, Bloods, Crips and MS 13, are all known to engage in retail trafficking of heroin and both property and violent crime. In the northwest, nationwide gangs have less impact, but Native American dealers can easily transport large quantities of heroin from cities like Portland onto their reservations.

During the decade that heroin use fell, methamphetamine and prescription drug abuse soared. Now these numbers are stabilizing, and in the case of methamphetamines, seem to have peaked, so tribes wishing to act proactively to stop this new drug plague can use the same tactics and resources used in fighting meth to prevent heroin abuse and related criminal and gang activity in our communities.

The first step in effectively combating heroin is for tribes, tribal leaders, elders, adults, and youth to learn about the collateral impact drugs have on the health and safety of every community member. No one is immune from the impact of drugs. Community awareness and education is vital to first recognizing the threat. Many tribes have the expertise to develop a front-line response while incorporating traditional approaches in education and prevention.

Elders and tribal councils can support the efforts of professionals in our communities to prevent and manage heroin abuse by being vocal advocates for increased programs and governmental funding. Tribal leaders can also encourage a good working relationship with agencies in our communities, including outpatient care; law enforcement, courts, and social services to support community members in their effort to remain substance abuse free after they have undergone treatment.

Walter Lamar is President of Lamar Associates. Lamar Associates Indian Country Training Division offers culturally appropriate Drug Abuse Training for Indian Country law enforcement and service professionals in both on-site and online courses. Visit our website for more information.