 Hello and welcome to this edition of quality of life Today we're going to be looking at the aspects of heroin addiction and the consequences that can have on one's quality of life Joining us today to cover this subject is dr. Howard Croft from st. Nicholas Hospital emergency department Welcome to the show Howard. Good morning. Thank you. You're currently the medical director of st. Nicholas Hospital emergency, correct? I am and how long have you been doing that for about the last three years? Okay Okay, it's good to have you there Okay, the subject of heroin heroin addiction How long have you been dealing with this and making the presentations that you've been doing and making the awareness? Well, we put together This is a program that's been in place now for a little over I'd say a little over a year this started but but we put together a series of presentations one of the things we wanted to do is was obviously to educate the public and So one of the first things we did was to put together a presentation and we've then been taking this presentation around to the community to various school groups and Church groups clubs and the like. Okay With the problem of heroin, I know you are here. They should weigh in police department and their battles with trying to you know Reduce the amount of heroin being used in trafficking. How large is this scope or how large is this issue? Well, I think you know probably one of the first things to do is to kind of step back and eat the scope is Right now the fortunate thing is the scope is really large and to kind of put it in perspective You know when we start talking about heroin addiction we also kind of tie in prescription drug abuse as well and To give to give you kind of a little idea of where we sit The United States has about five percent of the world's population And we know that presently we consume somewhere in the range of 85 to 90 percent of the world's narcotics. Oh my goodness so So we have you know, I mean so we are so narcotics are very prevalent in our population in general And then the other thing is yes, we're starting to see there's there's just a rampant increase lately in heroin and And then we can we can get into why that is because there's several issues as to as to what has kind of caused the resurgence of heroin Okay, what about on a local level like here in Sheboygan Sheboygan colony or even Wisconsin is the problem Follow you know mirror what it is in the nation or are we above or below average? Well Again, I think that that's kind of hard to measure what I can tell you is that the problem is it's very prevalent It is all across the nation and there's certainly some pockets that are there are more prevalent than others but I think the important thing to note is that it is here it absolutely is in our community and I know one of the other things that we did over the last year was we sent out a community-wide survey and We got an actually we got a pretty tremendous response considering the population For Sheboygan County. We had over 1,300 people respond to the survey and the results of the survey were actually pretty stunning We noticed that you know over over a quarter of the respondents either knew somebody that was affected by heroin addiction whether it was through theft and crime in their area whether they knew somebody that had sought treatment and Almost 10% of the people that responded Basically said that they knew somebody that had used heroin within the last month So again, we're we're faced with a problem that is you know, we can't deny it It is it is absolutely within our community I will definitely agree because I have friends that I know who have the experimented with drugs I didn't even know over would even think so Definitely and it can be hidden pretty well too at first Well, and it the other thing is it cuts across all the different patient popular it cuts across all the different populations It's not isolated, you know when we used to think of heroin we used to think of people in the back alleys We used to think of people that you know the poorer populations and the like and the reality is Today's heroin addiction is it cuts all across the board. It's it's wealthy. It's poor It's rural it's suburban We're seeing it pretty much everywhere and so Sheboygan County is clearly one of the targeted areas, okay? With your presentation and your experience and background with the project that you are working on Is there a case study or an example you'd like to share or bring into the mix? well a lot of times when I give the presentation we we do give I do like to give a Kind of a case study if you will something that kind of some people kind of kind of relate a little bit to what it looks like And the case that I typically have used is a 17 year old who we found Basically unresponsive who was found unresponsive in a bathtub and had track marks and track marks are little scars They're scars that are along the sites of veins For people that have injected IV drugs this 17 year old was not able to be Was not able to be resuscitated And ultimately died To two things that are kind of interesting one is that it's not unusual for us to find these victims in bathtubs heroin typically kills because it it basically stops the person from breathing it basically suppresses your respirations and And it's kind of it's kind of a little bit of a myth that if you Put somebody in an ice bath that they're going to gasp or somehow start breathing again We know that that's actually not true in this case obviously it wasn't true But the reason the main reason that I bring up this case is because this happened. This was my home This happened. I was 15 years old and This was a friend of my brothers and I came home and and again it it What it showed me was that it can be anywhere And and you know we I grew up in a in a middle-class suburb and so It's not again. It's not a problem of You know it cuts across all populations. It's not necessarily a problem of rich or poor and It has the it has the unfortunate ability to affect any of us well, well With with the problem at hand why heroin why has it returned? Why has it become so popular over the other types of drugs? Well, and I think that that's a good question There's a I think that there's a bunch of things that have gone on Over the past several years that kind of have led to where we are with heroin One of the first things that happened was in the in the late 90s there was a big push by the federal government and a by a lot of our regulating agencies for for Physicians to aggressively treat pain. In fact what we did was we There was a campaign put on by our by our accrediting organization And they listed pain is what they called the fifth vital sign So they really pushed it on physicians that we were supposed to really aggressively treat pain and so the With that big push one of so what happened was You saw a big flourishing You know prescription drug You saw prescription drug use actually skyrocket The other thing that's gone on is is over the last several years We've become obviously we've become Significantly aware of the problems of prescription drug abuse and so we started to clamp down on that And that's happened a couple a couple different ways in 2000 in the beginning of 2013 Wisconsin put together a website. It's a prescription drug monitoring program and That website allows us to take a look for each individual patient that we're treating We can look on that website and we can see all the prescriptions for controlled substances that that person has failed so that gives us a real good idea of Whose potentially misusing prescription drugs That's one aspect and then the other thing is we start to see the federal government has started to change certain things like formulations In two thought for example in 2010 They changed the formulation of Oxycontin So that it could no longer be put into a liquid form because what we had was so there were a lot of people that were taking Oxycontin they were they were Getting it you know dissolving it in water and injecting it The federal government recognized all the abuse of Oxycontin and basically started to take steps to curb that So really what you started to have is you started to have the pendulum swinging back We had all these people that were using prescription drugs and now we started to restrict find ways to to restrict their use and restrict the potential for abuse and So what we did was we started to create a situation where actually Heroin has now moved in and the reason that heroin has moved in is because it now is cheaper unfortunately to get heroin and Then it is to to maintain a habit for of prescription drugs Really? Yeah, and that's that's a shocker. That's why and that's a lot of why we are where we are right now And then the other thing we note is that And again prescription drugs are they're everywhere a Lot of young people get into it whether it's with their mothers or fathers drugs that you know are in the cabinet around the house or grandma's drugs or whatever it is, but But it's not difficult to find the first few pills or so And we also know that it's a gateway drug the prescription drugs are how that's how heroin addiction typically starts that Most people that get addicted to heroin start off with pills. I Know if I may add there's a few times when treated in the hospital or doctor's office where you know What's your pain level? You know the one to ten scale enough? I'd say that's a two or three well, then I would get a prescription You know whether it's oxycodone or whatever or like in the hospital Well, they hung a bag of you know a little bit of demoral and I'm going that stuff to me Just kind of wipes me out you get kind of all dizzy and kind of tingly and such and you know It may think it makes me more try to forget about the pain and when it really solves the pain You know I can still tell the pain is there But it just numbs you up so much that you really don't pay attention to it at least that's how it affects me Well, and and again, I think what you're describing and that's really true It kind of numbs you up There's a little euphoria Associated with it and we know that that's what so and particularly with heroin if you inject heroin the unfortunate thing is you get a very rapid intense euphoric feeling and And that's what makes it so that's what makes it so terribly addicting and we know that 75% of people That try heroin We'll do it again So so we've got to stop it before it even starts that's going to be the key So we've identified heroin as obviously went to the major issue I know you talked about a little bit already, but if we could go more into What is it really and how is it used? I know injection is one method What are other methods that you can use with heroin? Well, that's so there's kind of two parts to that The first part is what is it? Well heroin is heroin is It's a drug that is made from the resin of the poppy plant And so there's and you know if you go in like Afghanistan, that's I think that there's that's like their number one cash crop And what they do is they they harvest this resin They get it into a nice powder form and then they end up Shipping it across the country and it or out of the country and and it finds its way to us in the United States The other issue with heroin is it doesn't just come to us in its pure form So not only not only do you see heroin that's coming across, you know Again, it may be it's a lot. It's a lot stronger or more pure when it comes into the country What ends up happening is It gets cut if you will that's what they call it. So what you do is so they add other Compounds to it to basically increase the amount And one of the other problems that we have is depending on what they cut it with Some of the some of the things that they cut it with Can be dangerous in and of themselves? So we're seeing Things like you know that you can see things like There's Dorman, which is a which is Benadryl. You can see some benign things like that But I know in the area. I know the police have actually found heroin that was cut with Ajax So there's some terrible stuff that's out there There have been a rash of deaths in the east coast from heroin that was actually cut with a more potent narcotic called fentanyl so Again, one of the problems you run into is It's this is not a pharmaceutical. It's not a it's not a you know, this is not a drug that's made in a lab There's no pharmaceutical regulation You really don't know what you're getting the percentage of of the heroin that you're getting can vary all across the board I know that most of the heroin most of what I seen quoted is that there's that the purity of heroin that we see here in Wisconsin is in the 15 to 20 percent range But I know that we've seen according to state lab. We've seen heroin. That's up to 70 percent pure well and so the point is that you really When when people are injecting this stuff They they may not necessarily know what they're getting and so they may end up getting into significant trouble Because there's variation in the purity and It's it's adulterated with all sorts of different types of compounds. Wow Wow What are a lot of the effects of the drug? Well take it and and we should go back Initially, I would say initially most people start off with smoking heroin so heroin can be smoked It can be it can be ingested or it can be injected The unfortunate thing is most people choose, you know initially they start off. They may start off with smoking But eventually they move to the injection and the reason is because of the intense euphoric rush that people get from it As far as the effects of heroin Again, we said there's this intense initial euphoria and then afterwards you start to see people they start to go They start to kind of like go In and out of kind of like a sleepy face. They call that being on the nod So there's periods where they're more wakeful and there's periods when they're more sleepy If you actually go on the internet you can look up You can look this stuff up if you put it on the nod you actually there's all sorts of videotapes of of people Falling over and falling into objects that are on the nod And as you you know might realize I mean, I you know to have somebody potentially driving a car You know after having used heroin You know the potential for danger for the rest of the community is just huge absolutely As far as the medical effects a good way to think of it You know we always think of narcotics a good way to think of it is it is that it slows down everything so Narcotics and heroin what they do is they'll slow that they they lower your blood pressure They slow your pulse and they depress your respirations And they also actually depress your temperature too And the way people get into trouble as we said before the way people get into trouble is that they end up unfortunately They they we suppress the respirations to the point that they basically stop breathing And there's no way to really resuscitate them because it's that far past well, and again, it depends on when you get to them There yeah, there is you know, and we are we are starting to work on Legislation actually on statewide and actually national to get there. There is a there's an narcotic antagonist called Narcan Okay, and we're starting to get that out into out into the community in the hands of In the hands of our ambulance personnel so that if they find somebody and they think it's a I think it's a heroin overdose They'll be able to admit the administer that Because that actually that pretty rapidly will turn around the effects of the heroin. Okay So in your case study or someone who starts down the heroin path and you keep on going What are the consequences eventually they're gonna face? Well, no net path again There's there's kind of there's the short-term consequences that we kind of talked about the whole you know decrease in respiratory rate and stopping breathing and Then there's the long-term consequences because again, you're injecting something into your vein that That is uncontrolled. There's no Regulatory industry or anything like there's nothing to controlling that and so you end up you can end up with Effects locally so you can do damage to the vein and the local tissue. You can end up with skin abscesses And the other thing is what you inject into your veins goes directly to your lungs and heart And so we see people that end up with heart valve infections and Significant lung infections from it from injecting, but you know for materials and infected materials into their veins And then the other thing we see is you know people I mean this so far. It's not the cleanest You know, unfortunately, this is you know, people may share needles and it's not the cleanest You know, they don't always use the cleanest injecting techniques and so they can end up with you know HIV and Hepatitis also is spread by IV drug abuse. So both hepatitis B and hepatitis C So there's all sorts of there's all sorts of systemic and long-term effects And then obviously the thing that unfortunately the thing that we're you know seeing the most now is we're seeing You know deaths in the community from the short-term effects. Well Well, how can I how can I tell if somebody's actually using or abusing heroin? Well, and I think again that this is a great question this is when when we're giving these talks to the community what we want to do is we want people to be able to Look at their family or their friends or acquaintances we want to kind of educate them on what are the signs that they need to look for what things and Again, I think that they're pretty common things, you know, we see people who start to withdraw socially We see changes in you know for kids we can see changes in school work We can see people who are you know Starting to be secretively that kind of stuff. We also see people that again, you know They talk about wearing long-sleeve shirts and hot weather Not unusual, but I would say One of the biggest things that we see is we see we see theft We start to see, you know, I mean if you have a family member and all of a sudden stuff is disappearing around the house Whether whatever kind of valuables money jewelry, whatever it is TVs That's a big red flag and you see that kind of stuff you see change again the changes in behavior those are things to really tune into and and really for you know For most people I think that I can tell you that when I talk to families who are loved ones where someone has died from From heroin we see that in the emergency department To a tee every single one of them Every single one of them will say, you know, I I I saw things and there were things I knew something was wrong and I and I just didn't say anything about it. I just didn't do anything Okay So the other side of it is is we've been through the scope of how it can affect people how they take it, you know, the Consequences, what can we do to really turn us around? Well, and I think that the first thing that we can do is what we're doing today We can talk about it, you know, we can take it to our schools. We can take it to our church groups We can we need to let people know that number one. It's out there. It's in our community We can't you know, you know hiding our head in the sand is is absolutely the wrong thing to do We need to be willing to talk about this stuff. We need to be open and honest about it and Once we identify it We need to be able to give people we need to empower people. We need to give them resources, you know, you know, where do I go? Who do I call? You know We need to we need to not be looking the other way if we're going to make a dent in this and We're going to prevent our our children from being affected and our neighbors and friends from being affected We got to be upfront with this and we got to be willing to talk with people and confront when we when we see the signs and symptoms With what you just described, I think it's a great great approach Taken into effect, you know if we had this type of a program back when your brother's friend had his mishap Do you think there could have been any chance that would have been noticed or education and would have been a chance to save them? Oh, I think that I think that there's no question. I think that that's that's absolutely the case again, you know Now you this was a long time ago, obviously But we have we have you know We do have a fair number of community resources that are available and we do have the ability to intervene And I'm not going to tell you that there's not that there's not a high, you know rate of recidivism There's not I mean, it's it's not an easy thing to treat correct But we absolutely know that if we do nothing there is clearly a downward spiral and there's a and and there are people that are affected and And there are people that you know that people we've had we have several We've had several deaths last year in our emergency department and that doesn't even speak of The the people that were found dead in the community that didn't even make it to the emergency department So so yeah, this is I mean this is a big deal and and we have to you know That's one of the things that we're trying to do is We need to be able to have available to people the resources to treat this We can identify it and and we do you know We have we do have some community resources, and I think one of one of the things that we're trying to do with this program Is to increase the number of resources that we have available for treatment? I Don't want another Statistic or issue that I've noticed you know just mine and here at the TV station as well as a Lot of people fail their drug tests when applying for work and I mean that's another consequence I think which then can contribute to the downward spire as well when they want to try and get a job and they fail I mean that's a huge issue too going on Yeah, no, absolutely now I and again You know I think I think the key with this thing is again. We need information. We need information to be out there There's no question. It has yes It has long-term effects on people that can certainly affect their ability to be employed in our community But but again, I mean a lot of these things these are a lot of these are life and death You know particularly with heroin You know This is this is a hold to me. This is like a whole it's a whole different animal I mean this is something that we can't you know, we can't ignore this We've we've got to address this We've got to educate people and then we talk about you know, so Where can people go and what can they do? And I'll tell you that the what we've done is through this program. We put together There's there's really kind of three resources that people can go to one is It's called the SAMHSA website and the SAMHSA website. It's S.A.M. S.A.M. HSA the SAMHSA website basically it's it's more of an informational website It's a national website that gives people information on Addiction and what treatment and what treatment and like might look like Locally, there's two really good resources one the one that I recommend the most is mental health America And there's a there's a there's a phone number for mental health America that we should definitely put up and The key with mental health America that I the thing that I really like it's kind of a one-stop shop So basically they have the they have They can talk to you about what kind of you know insurance or what whatever kind of whatever your situation is And they can guide you to the resources that are available in our community The thing with mental health America is they're not they're not 20. They're not available 24 7 and so on the off hours We also have a Sheboygan County mental health crisis line and that is man 24 7 and and that crisis line can also steer you to the right resource And I would again I would encourage people when you find out about this stuff The the most important thing is not to look the other way And then the other thing is and we've been you know, we've been trying to promote You know, we want the community to understand That this stuff is out there and this stuff affects people and and so there are billboards We put up a couple billboards the state of Wisconsin has Has put in a website called the fly effect calm and if you go to the fly effect calm the neat thing about that is You'll actually see a bunch of case studies People have been generous enough to spend time basically talking about the stories of their loved ones and how it's affected their Family and what's happened to them? And I again I think you know, it's a it's a wake-up call for all of us It's time for us to wrap so dr. Croft and love loved to have you on the show and talking about heroin I think this is a great episode Just to add on to what you know community awareness I know the shibuya police department has a program too that they're working with you So they're here that they're they're there to help as well So great resources to you know contact if you know anybody with issues or Have issues yourself and need to get help the other thing is our TV show We can broadcast this out and get the message out there, you know really more widespread so again I thank you for being on the show. Well, you know and again, thank thank you for having me I mean this again, this is this is a great issue that that we really need to educate our Community on so I appreciate the opportunity to do so. Thank you This concludes our episode for quality of life the heroin abuse on behalf of dr. Croft WSCS. I'm Dave Augustine. Thank you for watching