What does insufflation mean in relation to powdered street drugs?
Insufflation means to push or draw a substance into a body cavity or dead space using air pressure. While the word has multiple meanings, it means just one thing when it comes to drugs: snorting. The act of insufflating a drug, such as cocaine, methamphetamine or heroin means to snort it up into the user’s nose and nasal passages. Why is a drug insufflated? Because it is a fairly effective way to get high from a drug fast. While slower than injecting or smoking, snorting a drug gives a faster and more potent effect than swallowing the same drug. In fact, some drugs are only minimally active orally, so insufflation is the preferred route.
Why is insufflation a gateway to heroin use?
Imagine an opiate user going to their street drug dealer to buy pills. This is fairly common in the US. There has been a crackdown on medical pain management. Patients have had their meds cut in half repeatedly by doctors responding to mandates from their states and the federal government. What is it like to have your doctor tell you that you will be getting only half of your needed medication this month? You would ask why of course. How would you feel if your doctor told you that it is because of changing laws or fear of discipline?
The circle is now complete.
Of course, many pain patients will just accept that they are getting far less medication. While they may suffer, they will do so quietly. The CDC released a report in 2016 which many officials have taken as a mandate to severely reduce medications for chronic pain patients. While the CDC has recently admonished doctors, law enforcers and politicians for misinterpreting their guidelines, the damage has been done. There is an increased risk of suicide among undertreated chronic pain patients and there is a decrease in quality of life and productivity. Unfortunately, some of these patients will turn to the black market for relief. This means buying pills from a drug dealer.
Pills to powder.
Black market opioid pills are not cheap. Street prices tend to be around $1 per milligram. This works out to hundreds of dollars daily for some users. And, there are often shortages of these pills on the streets. What happens when a dealer is out of pills? They may recommend heroin as an alternative. The same may happen if the user is short on cash. Heroin is cheaper than pain pills. When the user is suffering in physical withdrawal and possibly severe pain, it is an easy sell. Heroin converts to morphine in the body. It is easy to justify that the switch is not that big of a deal. Yet many opioid users have never used a needle to take drugs and suggesting that they shoot up will be a deal-breaker.
Insufflation is the gateway.
Here is where the dealer can finalize the sale of heroin to a pill customer who never considered buying the dangerous street drug before. They tell the user that all they have to do is insufflate the drug into their nose. Snorting does not seem to be that big of a deal to many users. Many pill users have already experienced crushing up their pills and insufflating them. They do this to get more potency out of a dwindling supply of pills. Now, an opiate pill user is on heroin.
The next step: Fentanyl.
The culprit behind many, if not most, of the deaths in the opioid epidemic, is fentanyl. This is not the hospital fentanyl or cancer patches or lollipops that you may have heard of. This fentanyl is made in clandestine labs in China and shipped through the US Postal Service to drug dealers. It is then used as an additive or replacement for heroin. It lowers costs and increases potency. Unfortunately, it can dramatically and unpredictably increase potency and lead to deadly overdoses.
How much of the US heroin supply is tainted with Fentanyl?
I would say that all of it is affected at this point. I don’t remember how long it has been since we had a heroin-using patient in our office who came up positive for heroin and not fentanyl. It has been a while. While many are positive for both drugs, some are positive for only fentanyl. Often, the patients are not even aware that they are insufflating pure fentanyl.
From injury to the insufflation of heroin and fentanyl.
Now, you can see how a person can go from being in an accident to developing chronic pain to being prescribed opioids to the insufflation of heroin. It is not as far-fetched as you may have thought. So, when you discover that a loved one is using heroin, you should offer to help them to get help, but please have empathy for their predicament. Few people walk out of their door one morning and decide to get addicted to heroin. In fact, becoming a heroin addict could happen to almost anyone.