When Peaches Geldof was found dead in her own home with no apparent explanation, the world was baffled as to what killed her. She had recently given an interview about how she was enjoying being a mother and had never seemed happier.
Then came to autopsy report which revealed she had died from a heroin overdose, and we were in shock. Not just because it was the same drug that killed her mother Paula Yates, but there were no outward signs that she was a heroin addict. The most recent inquest into her death found she hid drugs in her loft and at the scene of her death, there was paraphernalia around.
All of this reveals a lot about stereotypes, and how they don't quite apply to heroin.
Heroin, if we're being brutally frank, has always had the reputation of being the skanky drug. For most of us, the spectre and reputation of what we know about heroin - deadly, highly addictive - is enough to scare us off ever trying it.
Even recreational drug users know it is not a drug to be messed with. Although the good news is the numbers of heroin users is falling - according to the National Treatment Agency for Substance Misuse in 2013 - there is no room for complacency: heroin is still a drug that kills and persistent use will almost ultimately end in death.
That there is no fixed idea of what a heroin user is like is important as a starting point to understanding the drug - rich or poor, famous or not - it is a drug that can be used by your neighbour, your family member or your colleague.
HuffPost UK Lifestyle spoke to Dr Niall Campbell, consultant psychiatrist at The Priory, who explained why heroin works differently to other drugs. "It's a downer, not an upper," he says. "For some people, it's a love affair for life. As Superhans from Peep Show says - well, he's talking about crack rather than heroin - it's moreish. It is very addictive and probably more addictive than all other drugs. Therefore the user must have more, they love it and want to have it again and again."
While people take 'uppers' - for example, cocaine, to enhance an experience, people tend to take heroin to deal with reality.
"It’s a sedative drug," Dr Campbell adds, "so it has a calming effect and has a depersonalizing effect – it gives you a floating feeling and can be quite tranquillising.
"Of course, it’s also a painkiller. It can be so tranquillising to make you sleepy. It can so respiratory depressive as to make you dead, depending on how much you take. It can also make people feel sick, so it’s nausea inducing. That puts some people off but some prefer the positives so much, they are willing to overlook the negatives."
There are two ways that heroin kills, says Dr Campbell.
Heroin is toxic to the brain because it depresses the respiratory sensors. Take too much and you literally stop breathing. This, he adds, is what killed Philip Seymour Hoffman. People at risk of this are users who quit using heroin and then start again, taking the same dose that they took when they were regularly using.
Another way is when people take too much and it causes them to throw up, which they then inhale and choke on.
But why is heroin 'probably more addictive than all other drugs'?
"It mimics your endorphins," says Dr Campbell, "and you list drugs according to addictiveness. It is an opiate and is more addictive that cocaine. It does override your ability to stop because it’s so moreish. Some people love it - they think about it and crave it – it takes over their lives."
Although Dr Campbell says that it's seen as the "skanky dirty Trainspotting type drug, associated with the tenement council blocks", a person deciding to use can depend entirely on their circumstances.
"Often they will be with someone who is a user and will have a go. It can absolutely grab you for the first time. It can also be that in certain places there are people dealing the drug and this makes people more at risk. I’m from Ballymena in Northern Ireland and there was a family who was dealing it and it became a real problem in the 80s and 90s."
Heroin has a much worse reputation than other drugs, that much is established. But unlike people who use cocaine, there is a much more vehement stigma against users.
We spoke to a recovering heroin addict David Marshall*, who said: "Having begun using drugs and alcohol at age 13 in part at least as a response to burgeoning mental health problems and an overwhelming feeling of being an outsider, incapable of fitting in, I would concur with the majority of ex-addicts I know who talk about 'never having felt comfortable in their own skin' until they found heroin, a drug that – initially at least – takes away the emotional and psychological pain those who walk that path invariably suffer from.
"This is not weakness, but the result of a complex set of emotional, psychological, societal and family/upbringing-related factors, such as difficulty in dealing with the consequences of physical and sexual abuse in the home, depressive conditions and other mental and emotional health issues."
The news that greeted Peaches' death was one of shock. No one knew that this was a problem for her or indeed, even that she was using. David says that this can be common among users.
"Beyond the social stigma associated with heroin use, the drug destroys self-belief, leading users to believe they cannot live without it. It isolates them from the friends and family who could help them into recovery."
David is keen to point out heroin is viewed as a physical addiction - when it is also psychological - and the biggest misconception is assuming that going into withdrawal - or cold turkey - is actually the hardest part.
What is hard is that in the sober light of day, the user is then left to live with and examine all the things they were trying to escape from - all of things that heroin made easier to absorb.
So what are the options available to someone trying to quit? Dr Campbell says: "The stopping in some ways is the easy bit but the memories of your childhood, your relationships - the things you find tough - that’s what you have to deal with. In the Priory you have help and the recovery rates are higher, but not everyone can afford it. NA - Narcotics Anonymous - is very good to help keep people in recovery."
One of the biggest problems, however, is the government's stance to handing out methadone prescriptions to users, and seeing this as the most successful way of dealing with the problem.
David says: "The most dangerous assumption about heroin prevalent among policy-makers and medical professionals that replacement therapies such as methadone are an effective treatment for addiction.
"The vast majority of junkies use their methadone scripts to avoid getting sick when they have no money to score – and simply add methadone addiction to their list of problems, continuing to use street drugs. The fact that in my first meeting with a local authority-employed key worker she told me 'I don’t care if my clients also use heroin' demonstrates those on the front line have no confidence in methadone as a ‘cure’ for addiction."
For friends and family, it is a tough road.
"Common emotions felt by families include guilt, isolation, fear, helplessness and anxiety," says Adfam, the charity that supports friends and families through addiction.
"There can also be relationship difficulties, financial problems (e.g. paying for drugs/paying off drug debts), physical and verbal abuse, and problems at work like stress-related absence or taking time off to care for the substance user. Families may struggle to cope with conflict with the substance user, or with issues like boundary setting. Families often feel stigmatised and alone, not wanting anyone to find out what’s happening – they feel that having this out in public can be deeply shameful."
We have to hope the number of heroin users is falling, but for now, we can't forget or neglect the hundreds of thousands addicted to the drug.
In order to do that, we need to put aside our prejudices - isolating users won't help them, they are already doing that to themselves.
"Heroin addiction takes away everything," says David. "Treating heroin addiction as a physical dependency is an enormous mistake. Instead it should be treated as the equivalent of a serious mental illness.
"For families, watching the physical and mental health of their child, sibling, parent or spouse deteriorate; experiencing the person they care about so deeply become a skilled liar, cheat and thief due to the compulsion to support their habit; and the difficulty non-addicts experience in understanding why a user can’t simply stop and become the person they once were; is heart-breaking.
"The message I would give the families of users is that recovery is possible – with a great deal of care, love and support. Unfortunately most junkies have to hit absolute rock bottom before they begin to walk the path of recovery and by that time they are usually completely isolated from those who could support them the most."
For support around this issue, visit Talktofrank.com. For friends and families support, visit Adfam to find a support group. To connect with Narcotics Anonymous, visit the website or call 0300 999 1212.
*Name has been changed
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