Hooked on heroin: how are we treating it?
He guides the needle smoothly into a shrivelled vein, with expert precision, careful to avoid any blowouts or a citric burn. Letting go of his friend’s limp arm, he watches him drift into a ‘good’ place, content there’s no overdose risk. The naloxone kit is stashed away, safe from any potential needle thieves. He’s had training on the opioid antagonist and he knows how to use it to save a life. He realises someone might have to use it to save his life one day. He takes a breath, sucking in a thousand unseen hurts and checks his own scarred arms and hands for the best entry point. His turn now. Time to block everything out. His racing mind is punishing, a torrent of festering loss, self-loathing and fear. It taunts him, jabs at his weakness, undercuts his free will and bullies him into using defeat. Heroin, once all the impurities its cut with have been filtered out, is the only thing that makes him feel normal. The risks diminish at the thought of the warm rush he knows is coming. Risks he puts off for another time. Unpaid debts. Lowered tolerance. Expected favours. In his mind, there is no other way. There is no way out.
He begins again, the ritualistic preparation of cooking up heroin, preparing for the next hit. He spreads each piece of equipment out before him, almost like it’s on a surgeon’s table. Packaged needles, clean spoon, sterile water and a new filter. He reaches for the kit, deep in thought. People like him to jag them. His careful aim is reassuring: every drop hits the mark. In a different world, he might be a phlebotomist. But this is his world.
For years, stretching back to his late teens, heroin use has become an intrinsic part of his identity. Without it, he feels lost and dysfunctional, a fish out of water. Its tenner bag of golden abyss masks all the things he avoids; painful memories and emotions from traumatic childhood experiences, accepting responsibility and the daring, elusive hope of achievement. Failure, like a familiar old friend, keeps him company, keeps his dreams of breaking the mould in check. Not many people know about his musical talent or the intellectual books he likes to read. Or how the library can sometimes be the only place he feels safe, although his attempts to blend in are futile. He no longer winces outwardly from the disgusted looks on faces he encounters in public places where it's determined in a silent universal agreement, that he has no right to be. They see chaotic and unkempt; a shifty, scrawny character who might be potentially harmful.
I don’t know why their kind are allowed in here after some of the things they’ve done.
They are some of the most harmed, most vulnerable and damaged people in society. His philosophical mind, kind spirit and internal pain are invisible to those who choose to judge on external appearances alone, without offering an ounce of civility or curiosity about the person sharing their space. For them, he represents a scourge on society, a blighted breed of outcasts. There’s no infrastructure to cling onto; no family unit, no first-class ticket out of the impoverished labyrinth of towns whose very streets cause him to break into craving sweats, their pavements pounded by dealers and users. There is no escape. Or is there?
Assertive outreach programmes such as Change Grow Live’s, allow substance mis-users to access much-needed help in the community, prisons and hospitals. Along with statutory and independent drug and alcohol services and ground-breaking, smart recovery groups, help for the majority who are unable to afford private rehabilitation costs is available in a more accessible way. Adopting a pragmatic attitude in tackling the epidemic of drug and alcohol problems in the UK makes sense, allowing former stagnant methods and stigmas to be challenged, and changed into a more successful working model. By breaking down barriers, standing firm in the face of discrimination, access to addiction treatment is made possible.
Junkie, he says. I hate that word.
Recovery involves building an important alliance, working collaboratively towards a goal that fits every individual who struggles with substance misuse in their life. Somewhere along their life journey, drugs and alcohol became the self-medicating demon they turned to for support. But change is always possible.
He’s had more than one chance. We must draw the line somewhere.
But recovery involves offering him another chance. And another. Knocking, not pounding, on doors again, and again. In understanding how difficult that internal struggle is, how each person deserves to win their own battle should they choose to fight, support is given through tenacious honesty, motivational interviewing and linking into a vital network of agencies who are willing and ready to assist. That assistance means help not only with the addiction itself but with life-saving, harm reduction through naloxone training, housing, jobs, benefits and mental health support, delivering a realm of alternative possibilities and an opportunity to turn a different corner. A corner away from the huddled temptation of hooded associates, drinking in the underpass, lurking in the pharmacy, eager to whisk him away to score, to escape, to self-destruct.
Respect and mutuality, professionalism and a desire to show up – for himself – all play a part in the supported, unfolding outcome. In this version of his life, he can learn to respect himself, to feel good in the community again, to give back, change and grow and live.
Finally, Andrew feels human.