I ask my patients who are addicted to heroin how they got started.  Many tell the same tale.  Injury.  Prescription for Percocet or Oxycontin.  They got addicted.  Prescription either went away or couldn’t keep up with their growing tolerance.  They started buying pills on the street.  Then they learned heroin was cheaper and worked even better and was more widely available.

But not all people become addicted to heroin this way.  Here are three patients’ stories.

Shelly worked in a restaurant.  She was a twenty-eight year old single mom, who was going through a hard time.  Her daughter’s father had left them and she was staying with her mother and stepdad who she felt were always judging her poorly.  She noticed one her coworkers was happy all the time, no matter what was going on in his life.  She asked him how that was.  He said he used heroin.  So she tried it with him one night.  And she had never felt so good.  All her cares when away.  Three years later I am taking her from jail to the hospital for nausea.  She was arrested for missing a court date on a theft charge.  She no longer lives with her mother and stepfather who have custody of her child.  The address she gives me is different from the one on the booking sheet, different from the one in our computer, and different from the one on the hospital face sheet.   She moves about.  She says she was on methadone for awhile and that actually was working for her, but because she didn’t have insurance and wasn’t on Medicaid yet, they charged her $65 a week and when she fell behind, they kicked her out of the program.  She went back to injecting heroin.  She has recently gotten on Medicaid and hopes to get back on methadone.   She says heroin still makes her feel great though not quite as happy as she first felt.  She regrets trying it.  She is tired of living like this.

Janet is a twenty-years old with a one year old boy.  She is staying at a shelter for addicted moms.  The baby tripped trying to take a step and has a bump on his forehead.  He cried immediately and is acting normally, sucking on his pacifier.  She has him in a car seat all ready for us.  She has been on methadone for two years, but is gradually weaning herself off of it.  As a teenager, she used to pick up heroin for her father.  He’d give her the money and tell her where to meet his dealer.   He was happy all the time, she said,  so one day she decided to try it, and got hooked.  Now she has a son she says she has no desire to have anything to do with heroin again.  He gives her the strength every day to fight off the urge to go back.

Ervin is fifty-eight and has been doing heroin since the late seventies.  I am taking him to detox from the hospital.  He tells me he got into heroin recreationally with his friends.  They partied every weekend –booze, weed, coke — and then one weekend one of his buddies brought along a friend who had heroin.  Some of Ervin’s friends who graduated to injecting, died of heroin overdoses over the years, but Ervin has been careful.  He snorts his heroin and tries not to get too greedy.  He is cautious particularly with the powerful Fentanyl that is around these days.  When he gets money, he uses heroin until his money runs out, and then he checks himself into rehab.  He comes out clean and then when he gets enough money, he starts doing heroin again until he is broke, and then he goes back to rehab.  It is the only choice he has.  He says it’s either rehab or robbing or killing someone to get the money to buy more heroin to feel his habit.  He is not a violent man and can not stomach causing harm to anyone but himself.  The cycle is his life and he sees no end for it.  He loves heroin he says –he is never more happy than when he is high, but he wishes heroin had never showed up that night.  He wonders what his life would have been like had he never let that demon in.  Don’t ever start, he says.

A drug company CEO who says his product is not addictive, a happy co-worker, a father too lazy to buy his own dope, and a friend of a friend — all selling happiness.  Fate comes in many forms.  There but for the grace of God go we.

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