• Area: Health Sciences
• Program: Health and Wellness
• Type of Writing: Essay (Explorative)
• Type of Writing: Profile
• Course Level: 1000
• English Speaking Nativeness: Native
• Year: 2021
• Paper ID: HS.H.a.W.E.P.1.N.2.2.2206

Heroin Use in Young Females: A Qualitative Research Study

Introduction

It is estimated that 53 million persons worldwide abuse opioids (UNODC). Heroin use has reached epidemic levels. In 2018, statistics show that heroin involved deaths are seven times higher than the number of deaths in 1999 (CDC). With these numbers climbing so rapidly, it begs the question, why do people use heroin? This research study is going to explore the background of two personally known female former heroin users to provide insight to these figures and the question of why they used heroin. While reasons for using heroin will vary with each individual experience, the subject’s answers will be compared to other research to identify any trends. The two subjects interviewed, Emily B. and Sarah H. are both personally known to me. Emily and I have been best friends since 2006; she was 14 years old and I was 16 years old when we became friends. Sarah and I have been close acquaintances since 2018; she works at an addiction recovery and treatment facility with my husband. Both subjects were asked the same 25 questions: five questions from five categories. The purpose of these interviews was to discuss heroin use among young females. The interviews were conducted both in person and via telephone call and ranged from about 40 minutes to nearly two hours. The questions explore the subjects background at the time of initiation and their initiation paths, their use and addiction career, their recovery experiences, and their current life in sobriety.

The first five questions were the “Control Questions” which were obtained from the study Drug Initiation of Female Detainees in a Compulsory Drug Treatment Institution. This study explored drug initiation among 46 Chinese women in a compulsory drug treatment institution with the intention of exploring four main themes in the analysis of participants’ drug initiation narratives: (1) involvement in high-risk social networks; (2) lack of family love and support; (3) relationship problems; and (4) male partner influence (Liu). The findings of this study were as follows:

“Findings indicate that the younger generation preferred starting their drug career with methamphetamines rather than heroin, due to the changes in the drug market and broader changes related to globalization. A lack of family love and support had a strong effect on the initiation of methamphetamine but not heroin users; however, male intimate partners and relationship issues showed strong influence on heroin initiation. Having high-risk social networks was a common narrative in the drug use initiation of Chinese women across methamphetamine and heroin groups.”

Control Questions

Question 1: When did you start using drugs? The findings of the interviews conducted with Emily and Sarah were contradictory to those of Liu’s study. The average age at initiation of heroin use in Liu’s study was 24.2 years of age while the average age of this study was 20 years of age.

Question 2: With whom did you initiate your drug use? Emily initiated her heroin use with a male friend, and Sarah initiated her heroin use with her boyfriend. Sarah initiated her Oxycontin use with her father. Both subjects’ experiences of initiation to use heroin were with males. While men and women were most likely to report self-initiation of heroin use, the second most reported influence for heroin initiation for both men and women was a male friend (Eaves).

Question 3: What was your experience of the drug at the initiation? Both Emily and Sarah had positive initiation experiences with heroin. Sarah was experiencing withdrawals from Oxycontin when she first initiated heroin use. The heroin immediately took away her withdrawal symptoms and she was overcome with a feeling of euphoria. Emily very much liked the feeling it gave her when she initiated heroin use, she did not feel very “high”, but she enjoyed the feeling.

Question 4: What was the major reason you think caused you to initiate drug use? Sarah initiated heroin use to avoid the withdrawal symptoms she was experiencing from running out of oxycontin. She knew she wasn’t ready to stop using prescription pills, or drugs in general. She needed to chase the next high to avoid withdrawal symptoms. Emily initiated heroin use because she was experimenting with other drugs at the time and was curious about the idea of trying heroin as well.

Question 5: What was your life situation at the time you initiated drug use? Emily’s family love and support were being challenged as her parents had recently divorced when she was 17 years old. Emily was the oldest of four children and she felt as though she was going through the experience alone because her siblings were too young to comprehend and experience it the same way she was. She also felt very alienated at high school, which led her to associate with high risk social networks. Sarah was also experiencing a lack of family love and support as well as associating with high risk social networks. She was 23 years old and living with her father, who was also a drug user, because she could not hold a job. She would get enough pills or heroin to keep a job for a short while, but once she ran out of drugs, she would call into work from being dope sick and eventually get let go. This led her into a life of selling drugs to pay for her habit and that became her entire life focus. From Liu’s study, 42.1% of heroin users initiated use due to involvement with high risk social networks while only 10.5% of heroin users initiated use due to lack of family love and support.

Expansion/Background

In an effort to better understand what Emily and Sarah’s lives were like at the time of their initiation to heroin use, a series of questions were asked to expand on their life in different areas such as their feelings about life in general, their family life, social life, and romantic life. Risk factors for heroin abuse include personal/family substance abuse history, poverty, child abuse history, stress, poor coping skills, unemployment, academic difficulty, and poor education (Barous). In general, Emily felt that her life was not grounded. She was feeling very stressed and depressed and was in search of a way to feel better. She felt alienated at school, and at the young age of 17, social networks are very important. This led Emily to associate with social networks comprised of other drug users. Emily’s family life was chaotic as her parents had recently divorced and she didn’t feel she had the support she needed at this transitional time in her life. The lack of support in her family life contributed to her association with high risk social networks. Emily was not seriously involved with anyone on a romantic level. At this stage of her life, her relationships were of a more casual nature and typically occurred with other drug users. When asked if she felt pressure from her sexual partners to use, Emily’s response was that she did not feel pressure from her sexual partners to use, but as her drug career went on and her addiction became stronger, her relationships began to develop from and rely on heroin use. “Drug relationships” are not uncommon as majority of women feel that their romantic relationships quickly became dominated by drug-related activities (using and procuring drugs), a considerable number used the term “drug relationship” when relating their everyday experiences, routines, and patterns of interaction (Mayock).

Sarah’s feelings about her life before she initiated use with Oxycontin were positive. She had a good job with insurance and felt she was living an “average” life for a young adult. Her father introduced her to Oxycontin and she was uncertain what it was – thinking that it was an antidepressant – but after just six months of use, she began feeling very sick and when she told her dad she didn’t feel well, he realized he hadn’t given her any Oxycontin in a while and that she was experiencing withdrawal symptoms. Given its extended-release nature, OxyContin had a large amount of the active ingredient oxycodone. When taken properly, OxyContin slowly releases oxycodone over the course of twelve hours. However, the extended-release properties could be circumvented by crushing the pill into a fine powder that could then be snorted, smoked, or liquefied and injected. In this way, a person could gain access to the full milligram content of oxycodone all at once and rapidly achieve an intense high (Evans). At this time, Sarah realized that what her dad had been giving her was a very addictive drug with severe withdrawal symptoms. Sarah continued using to avoid withdrawals and after a couple of years when her street dealer didn’t have any Oxycontin, he introduced her to a cheaper, more accessible, and stronger alternative: heroin. Among new heroin users, 3 out of 4 reported abusing prescription opioids before turning to heroin (Barous). Sarah’s account of her life when she started using heroin was as follows:

“When I started using heroin, at first, I felt it was a good thing, it was a secret thing that I did that other people didn’t know about and that somehow made me feel better. But eventually I fell into severe depression and thought this was all I would amount to.”

Sarah’s social networks were comprised entirely of other drug users and dealers. All family relationships and long-time friendships had deteriorated and all that remained were the “superficial” relationships she built with other users and dealers. The only close friend she had at the time was her boyfriend. Her romantic relationship was about three years old when she initiated heroin use. Her romantic partner used heroin as well and they fought all the time. They often fought while in the car and many times he would pull over and drop her off at random places or she would demand to be let out of the car regardless of where they were. There was no romance to their relationship, only drugs. Sarah’s family life was also broken. Her parents were divorced, but both had their own addictions and were living the addict lifestyle themselves, so they did not think about what Sarah was doing with her life. Sarah would often do chores for her parents if they would give her money or drugs as payment. When asked if she felt pressure from her sexual partners to use, Sarah’s answer was that she did not feel pressure to use, however she did feel pressure to run and sell drugs. Her boyfriend had a young child, so Sarah would do all of the drug running for them.

Drug Use and Addiction

In one study, while an equal amount of men and women reported becoming addicted to heroin within a year of initial use, 46.5% of women reported being addicted within the first 3 months of use compared to only 22.4% of men. This fast progression from experimentation to addiction appears to lead many women to move from snorting to injecting the substance in an effort to achieve a greater high and/or avoid becoming ‘‘dope sick’’ (Eaves). Emily initiated drug use by inhalation, specifically smoking heroin from aluminum foil. She transitioned to injection after she developed a tolerance from smoking. Most women who inject heroin point to social pressure and sexual partner encouragement as factors (drugabuse.gov). When asked if Emily initiated injection use due to social pressure and sexual partner encouragement, her response was:

“No, I did it because I knew I would get higher and it would hit harder. It was introduced to me through a sexual partner though. I had reached a tolerance from smoking and injecting allowed me to feel it more.”

Emily estimates that she had used heroin only three or four times before she developed a physical addiction. For her, the mental addiction came afterwards. Before she had began injecting heroin, she had a promising opportunity present itself, so she had told herself that if this opportunity worked out, she would quit heroin. The opportunity did not work out, so she began injecting heroin and noticed a shift in her mentality as the addiction set in. Emily did not encounter any near-death experiences during her drug career. She had a couple of experiences with overdosing when she mixed heroin with other drugs, however she does not feel they were close to being fatal as she tried to be very calculated with her dosage. Her intentions with using were not to die, but to feel better.

Sarah began injecting heroin from her first use. Because she was feeling dope sick due to withdrawals from OxyContin, no social pressure or sexual partner pressure influenced her decision to use the injection method. Sarah was already addicted to opiates from her experience with OxyContin and immediately she knew that heroin was going to replace her prescription pill use. Sarah reached a point in her drug career where heroin was not doing anything for her other than removing the withdrawal symptoms. She began adding cocaine when she would use heroin and nearly every time she did, she would overdose. The abuse of cocaine by opioid-dependent individuals is a ‘street phenomenon’ that has received clinical and experimental attention (Leri). Aside from her overdose experiences, Sarah also found herself in situations she would identify as deadly from encounters with people who would possess weapons such as guns or baseball bats, because she and her boyfriend would “rip them off” in their drug deals. Because she was expected to complete all of the drug running, she also was involved in numerous car accidents from driving while under the influence of drugs.

Recovery

Addiction is defined as a chronic, relapsing disorder characterized by compulsive drug seeking, continued use despite harmful consequences, and long-lasting changes in the brain. It is considered both a complex brain disorder and a mental illness. Addiction is the most severe form of a full spectrum of substance use disorders, and is a medical illness caused by repeated misuse of a substance or substances (NIDA). After living on the streets and running from the authorities for about one year, Emily was arrested and thrown into a maximum-security facility. She had been to jail a few times before, however this time was different. Due to an incident that occurred the previous time she had been in jail (she jumped off a second level platform and broke her back), she was placed in maximum-security care and it helped her see that she was ready to put in the work to change herself and get help for her addiction. Because Emily was in jail, her detox was difficult. She experienced hallucinations, restless leg syndrome, vomiting, she couldn’t keep food down, and she didn’t get much rest for about two weeks. She was aware of how to get help and asked for a therapist so she could begin treatment for addiction. After jail, Emily attended court ordered therapy – both group and individual. Emily also attended 12-Step programs; however, she did not find them beneficial as listening to others tell their stories of drug use triggered her to want to use again. Induvial therapy was the most successful treatment method for Emily, as well as having the support of her family.

Sarah began to realize that her behaviors were not aligning with her core life values. She was stealing and lying. On one occasion, she pawned her dad’s laptop and couldn’t get it back because any time she would earn money to get the laptop back, she would spend it on drugs instead. She also performed sexual acts for money. All of her values had been compromised due to drug use. As she began recovery, she experienced withdrawal symptoms:

“While using, I could go about 8 hours before I’d start feeling sick. My symptoms started off with a runny nose, sneezing, hot/cold flashes, diarrhea, vomiting, bone/muscle pain (restless leg syndrome), no sleep, everything tasted like shit – nothing tasted good except Dr. Pepper and sweet candy. Basically, no feeling comfortable at all. In recovery, I used suboxone to taper off, but I felt about all of the same withdrawal symptoms, just not as intense. It took about three weeks to stop feeling them in recovery and about 18 months before I felt the normal body feeling.”

At first, Sarah did not know where to find help for her addiction. It took her a couple of years to realize that heroin use is addictive in both physical and mental aspects. Once she learned that treating the mental addiction was as important as treating the physical addiction, she shifted her focus to how to get support for her mental addiction. Sarah tried several programs including 12-Step Programs, intensive out-patient and residential treatment programs, and sober-living. For her, the sober living was most successful as it helped her to stay committed to recovery. Because many of her family members were also drug users, Sarah had to cut off communication with her family for a long time. While she went through recovery, her support system primarily consisted of other people in recovery and other sober people. This is the key reason that sober living was so effective in her recovery because it provided her with the support that her family could not at this stage of her life.

Sobriety

Research shows that combining behavioral therapy with medications, if available, is the best way to ensure success for most patients. The combination of medications and behavioral interventions to treat a substance use disorder is known as medication-assisted treatment. Treatment approaches must be tailored to address each patient’s drug use patterns and drug-related medical, psychiatric, environmental, and social problems (NIDA). Emily recently celebrated her eighth year of sobriety and is living an accomplished life. She has worked at the same job as a Medical Biller for an optometrist for the past six years, she obtained an Associates of Science degree from Salt Lake Community College, and recently purchased her first home. Emily now has a strong support system of both family and friends. When asked how she maintains sobriety and what programs/treatments/religious or spiritual practices/etc. have helped her maintain sobriety, Emily responded:

“After the first three years, I didn’t have the physical draw to the drug. The last five years have not really been an issue other than when major life changing events have taken place. When those events do happen, I practice spirituality and psychology. Yoga has also been a huge influence in helping me to recognize myself, become more mindful, and learn to let go.”

Sarah recently celebrated her fifth year of sobriety and is also living an accomplished life. She has worked the same job for the past three years as a Lead Life Technician at an addiction treatment and recovery facility, she recently graduated with her Bachelor of Science in Criminal Justice from Weber State University, and she is studying for her master’s degree. Sarah has family members who still use drugs and those relationships have thwarted, however she has a strong support system of her husband, friends from recovery programs, and friends from work. For her first two years in recovery, Sarah attended 12-step programs. After a while, Sarah started having a hard time still having to refer to herself as an addict when she was trying to recover, so she has taken on more spiritual practices, such as Buddhism and Hinduism. She and her sober family also have frequently planned activities, such as hiking, that help facilitate her sobriety.

Conclusion

By studying the different aspects of Emily and Sarah’s drug career, the results show that more education on addiction and treatment programs is required. The results also show that exploring additional treatment programs could be effective. Emily and Sarah both had success with methods that required them to focus on themselves and become more aware of who they are as well as become more mindful in their thoughts and decisions. These methods were yoga, Buddhism, and Hinduism. It is presumed that addiction, which is a mental health disorder, may be better suited for treatments the same or similar to these. More research should be done on the spiritual treatments for addiction and other mental health disorders.

Works Cited

1. “Sex and Gender Differences in Substance Use.” National Institute on Drug Abuse, 28 May. 2020, https://www.drugabuse.gov/publications/research-reports/substance-use-in-women/sex-gender-differences-in-substance-use. Accessed 1 Jul. 2020.
2. Eaves, Cindy S. “Heroin use among female adolescents: the role of partner influence in path of initiation and route of administration.” The American journal of drug and alcohol abuse1 (2004): 21-38.
3. Liu, Liu, et al. “Drug Initiation of Female Detainees in a Compulsory Drug Treatment Institution in China.” Journal of Psychoactive Drugs, vol. 48, no. 5, Nov. 2016, p. 393. EBSCOhost, search.ebscohost.com/login.aspx?direct=true&db=edb&AN=119500411&site=eds-live.
4. Evans, William N., et al. “How the Reformulation of Oxycontin Ignited the Heroin Epidemic.” Review of Economics & Statistics, vol. 101, no. 1, Mar. 2019, pp. 1–15. EBSCOhost, doi:10.1162/rest_a_00755.
5. , Emily. Personal Interview. July 16, 2020. (name has been changed for anonymity)
6. , Sarah. Personal Interview. July 19, 2020. (name has been changed for anonymity)
7. Leri, Francesco, et al. “Understanding Polydrug Use: Review of Heroin and Cocaine Co-Use.” Addiction, vol. 98, no. 1, Jan. 2003, p. 7. EBSCOhost, search.ebscohost.com/login.aspx?direct=true&db=s3h&AN=8906535&site=eds-live.
8. Mayock, Paula, et al. “The Risk Environment of Heroin Use Initiation: Young Women, Intimate Partners, and ‘Drug Relationships.’” Substance Use & Misuse, vol. 50, no. 6, May 2015, pp. 771–782. EBSCOhost, search.ebscohost.com/login.aspx?direct=true&db=s3h&AN=103309376&site=eds-live.
9. Barous, T, RN, MSN, FNP, and N, RN, MSN, CNP Smith. “Substance Abuse: Heroin.” CINAHL Nursing Guide, edited by RN, PhD, FAAN Pravikoff D, Mar. 2018. EBSCOhost, search.ebscohost.com/login.aspx?direct=true&db=nup&AN=T701500&site=eds-live.
10. UNODC, World Drug Report 2019. https://www.unodc.org/unodc/en/frontpage/2019/June/world-drug-report-2019_-35-million-people-worldwide-suffer-from-drug-use-disorders-while-only-1-in-7-people-receive-treatment.html?ref=fs1#_ftn1
11. “The Science of Drug Use and Addiction: The Basics.” National Institute on Drug Abuse, 25 Jun. 2020, https://www.drugabuse.gov/publications/media-guide/science-drug-use-addiction-basics. Accessed 26 Jul. 2020.
12. CDC – National Center for Health Statistics – Heroin Overdose Data. https://www.cdc.gov/drugoverdose/data/heroin.html. Accessed 6 Jul. 2020.