Bange was aware of some of the medications that she could have used to help with cravings and withdrawal, Karen Cunningham said, adding she believes that Bange used a medication, possibly Suboxone, at some point in her recovery. Bange stopped because she considered it a « a Band-Aid, » Karen Cunningham said, adding « She just wanted to get clean. »
In 2014-15, 127 people died in heroin-related overdoses, and as of mid-October, another 37 had died this year. Gay said she has heard from many families that their loved one was clean before they died. It’s for that reason that Gay said she and her office have become « aggressive » at trying to decrease the stigma of medication-assisted treatment, which uses medications like Suboxone and Vivitrol to wean addicts off of opioids. The availability of such treatments varies in York County, and there are a limited number of doctors who can prescribe it.
« Very few die who are in a medication-assisted program, » Gay said.
The reason people who die from overdose after being clean for a period of time is rooted in biochemistry, said Dr. Debra Bell, director of clinical quality improvement for Family First Health.
A person becomes dependent on heroin, or other drugs or other things that aren’t drugs, because of how that stimulus works on the brain, Bell said. Other things, like exercise, work in a similar way.
“There are parts of the brain that will be triggered in different ways to create a dependency for anything,” Bell said.
Addicts quantify the amount of heroin they use to get high by referring to how many “bags” they take, Bell said. Over time, heroin users develop a tolerance for heroin, and need to take more and more of it in order to keep experiencing a satisfactory high.
Because of that tolerance, a person who overdoses in the midst of frequent heroin use is less likely to die, Bell said. Often, they lose consciousness, Bell said. And when such a person overdoses, it’s likely because they took more than normal or because there’s an increased potency or an added element, like fentanyl, in the heroin they’re taking, Bell said.
“It’s going to knock them out, but it’s not going to kill them,” Bell said.
But when a person has been clean for a period of time, like if they’ve gone through rehab and they have no opioids in their system, “at that point, their brain chemistry begins that process of resetting to the way it used to be,” Bell said. “So if they went back to using, and if they used that smaller amount, they would get high with that smaller amount.”
But if an addict doesn’t use a smaller amount — if they use the amount they had been using before they got clean — they’re more at risk of dying if they overdose, Bell said.
“Any opioid is taken into the body and in the same way we eat food, it gets broken down into smaller components,” Bell said. When the opioid is broken down, or metabolized, those smaller components bind with the opioid receptors in the brain.
“With opioids, heroin and fentanyl, they will make a person feel high, but they will also trigger that part of the brain stem that controls breathing,” Bell said.
When a person overdoses, the opioid overwhelms the brain, particularly that area that controls breathing, and it can shut down breathing completely.
Bell and Gay both said they believe a continuum of care is important for treating people who have a heroin addiction.
Getting clean is one thing, Bell said, but being able to stay clean involves so many different things, from housing to being in a supportive environment free of drugs.
Still, the addiction — the compulsion to seek out heroin and get high — is incredibly powerful, said Alyssa Rohrbaugh, vice president of York’s chapter of Not One More. Some people really want to stay clean after rehab, she said, but the cravings are overwhelming.
“People get high because they don’t want to feel pain,” she said, explaining that could be the physical pain of being dope sick while detoxing, or the emotional or psychological pain of trauma or stressors.
And as scary as nearly dying from an overdose sounds to nondrug users, Rohrbaugh said she has heard from addicts that hearing about an overdose can pique an addict’s interest.
“I’ve been told by addicts, if somebody overdoses and word gets around that they overdosed, they want to know where they got it from, because that’s good heroin, » Rohrbaugh said. “That’s the mentality of an addict.”
Bell said in great part because the addiction to heroin is so strong, the recovery process for most addicts will be long — measured in years, not weeks or months. But it’s something she wants to be part of, and she wants to see holistic approaches to treatment.
Seeing unsympathetic responses to news articles or community discussion about heroin addiction « tears my heart, » Bell said.
« Some people are at the mindset that this (addiction) is a choice. » Even if it is, she said, « We can judge all we want how they got there, fine, but once they’re there, what are we going to do about it? »