MR. KOJO NNAMDIFrom WAMU 88.5 at American University in Washington, welcome to "The Kojo Nnamdi Show," connecting your neighborhood with the world. Later in the broadcast, we look at the tragic fallout after a leading sports website outed a transgender interviewee, but first, Academy Award-winning actor Phillip Seymour Hoffman died yesterday from an apparent heroin overdose, highlighting a national trend that, unfortunately, has a local storyline. Last summer, a McLean, VA high school student died after injecting heroin.

MR. KOJO NNAMDIAfter peaking in the 90s, heroin use was in decline, but the long term decrease many hoped to see has not, in fact, happened. And an uptick in use by young people is an even more worrisome trend. Joining us to discuss this is Peter Reuter. He is a Professor of Public Policy and Criminology, and the Director of the Center of Economics of Crime and Justice Policy at the University of Maryland. He's also the co-founder and Senior Economist with the Rand Drug Policy Research Center. Peter Reuter, thank you for joining us.

MR. PETER REUTERThank you for having me.

NNAMDIAlso joining us, by phone, is Cynthia Moreno Tuohy, Executive Director of NAADAC, The Association of Addiction Professionals. She also joins us by phone. Cynthia Moreno Tuohy, thank you for joining us.

MS. CYNTHIA MORENO TUOHYThank you for having me, as well.

NNAMDIIf you have questions or comments, you can call us at 800-433-8850. What do you think is behind the apparent resurgence of heroin use? 800-433-8850. You can send us email to kojo@wamu.org. Peter Reuter, as heroin deaths make headlines, both in our region and around the country, most people seem to assume that we're seeing a spike in heroin use. Is that, in fact, the case?

REUTERNo, it really isn't. The use has been pretty stable. There will probably be some new estimates coming out, which show very little change over the last 10 years and the amount of heroin consumed in this country. The population of users is -- was getting older, and that's stopped now. But otherwise, it really looks like a -- just a continuing, significant problem, but not getting -- any noticeably worse.

NNAMDICynthia, on the other hand, among the young in our region, we are seeing some disturbing trends, are we not?

TUOHYWe are. In fact, what I would say, is that in Maryland alone, in 2011, we saw 245 deaths. In 2012, we saw 378 deaths. And in just this six months from September to current, we've had 91 accidental deaths, so it is growing. It's -- we're seeing it more in young people, and we're seeing it more in general. Particularly as we're seeing more prescription drug abuse happening, and then the tightening up of the pain pills. More control over those, and then people now moving over to heroin or heroin mixtures for that -- for the use of those medications.

NNAMDIWe mentioned that a high school student in McLean, VA overdosed last summer. It was her first time, apparently, using it, and most people start using a drug like heroin pretty young. You mentioned the tightening around prescription drugs. Do you think that’s having an effect?

TUOHYWell, I think that the prescription drug use is one thing. I think heroin is making a comeback among young, in terms of something exciting and new to do. But I think that people don't understand the effect that it has on the brain, and they don't understand how close you come to death with heroin. And that, what happens is that the brain gets flooded, basically. And it puts that major function of breathing to sleep. And so, I think we need to have more education to young people to help them understand if you have a friend, like in this case, that used and passed out.

TUOHYAs she was passing out, or as soon as they noticed that she passed out, that's when to get her to the emergency room. Don't take her home and let her sleep it off. She's not gonna sleep it off.

NNAMDIBecause you might not know what else is in her system. Peter Reuter, headlines in recent years have, perhaps, not only sensationalized the issue somewhat, but often muddy it. You point out that heroin overdose is perhaps not quite accurate all the time. Can you talk about that?

REUTERThat's correct. In a recent paper in the leading addiction journal, made the point that if you look at all the data that's been collected about deaths that are labeled as heroin overdoses, most of them involve another substance, often alcohol. And it's much more the interaction with other drugs rather than that the user took more heroin than they expected. So, it's really important that, if anyone is using heroin, that they have some awareness that using other drugs makes heroin use much more dangerous.

NNAMDICynthia, the McLean student had a common antihistamine in her system, highlighting perhaps another issue with heroin, the dangers, as Peter was pointing out, of using the drug in combination with other things. Can you talk about that?

TUOHYRight. Well, we know that a lot of the heroin use today, and I think Peter is right in that there are other drugs that are laced with heroin. Fentanyl has been one of those drugs that are laced or other antihistamines, and the difficulty is the synergistic effect that happens on the brain. And one doesn't know exactly what that's gonna look like, person to person, because each body, each of us are wired differently, and so our sensitivity to that may be marked higher in some people than in others. And, of course, with young people, their brain isn't fully developed, now they're saying, you know, until the early 20s.

TUOHYAnd their physical body isn't fully developed, and so you're putting a substance with other substances that causes synergistic or higher effect in the system. You don't know what you're gonna get. And I think that's part of that education people need to understand, is this isn't a simple, this is your mother's, this is your parents', this is your grandparents' medication that you're taking with something else.

NNAMDIIn case you're just joining us, that's the voice of Cynthia Moreno Tuohy. She is the Executive Director of NAADAC, the Association of Addiction Professionals. She joins us by phone along with Peter Reuter. He's a Professor of Public Policy and Criminology and the Director of the Center of Economics of Crime and Justice Policy at the University of Maryland. He's also co-founder and Senior Economist with the RAND Drug Policy Research. If you'd like to join the conversation, give us a call. 800-433-8850.

NNAMDIDo you think as society's views of drugs like marijuana soften, it is changing how we see harder drugs like heroin? 800-433-8850. You can send us a tweet at kojoshow or email to kojo@wamu.org. Peter Reuter, what, generally, happens when there's a combination of substances in someone's system?

REUTERActually, I think Cynthia will do a better job of answering that question than I will. Cynthia?

NNAMDICynthia?

TUOHYSo, heroin is the type of chemical that when it hits the brain, it turns to morphine. And think about morphine as the drug that had been given to people when they go into surgery. It just takes you a level above death. And that's done by, you know, someone who's trained with being able to keep you on that level before death. So, think of heroin as changing in the brain to sitting on your brain receptors to slow down any pain, and also to reduce your breathing and reduce your body functions.

TUOHYSo when you think about that, and you realize that the drugs that people are taking out there does that to their system, and that there's no one really out there to help measure, how is the breathing? How is the body functioning? Then you know that you're in a tough situation, where people can end up dead. Because there's no ability to monitor that. And then you mix other drugs in with it, or other chemicals, and you get that effect, that compound even much so. So, even though it feels good on the brain when you initially take a chemical, recognize that you don't have any control over that chemical.

TUOHYAnd you don't really know what it's laced with. And that's why we're seeing deaths with other designer drugs right now. Because you really don't know what it's laced with, and you don't know what your brain is gonna do in reaction to it.

NNAMDIPeter, you mentioned this earlier, but I'd like you to briefly go over it again. The longer term trends going back to the 90s, and what researchers thought would happen, and why it's apparently not happening.

REUTERRight. Well, none of us have been very good at predicting what happens with, in the long term, with drug use. Cocaine use is way down over the last, you know, since 2007, and I can say, confidently, none of the experts predicted that. With heroin, which has attracted less attention, it just looked as though it was a drug that had gone out of fashion, and you only had older users who were unable to kick the habit. And they made a pretty bad model for anyone who was thinking about becoming a heroin user.

REUTERAnd that would go on for a while. But famously, the historian who's studied heroin addiction most, talked about generational forgetting, the notion that, you know, after 20, 25 years, people kind of forget how bad the drug is. It comes back as a fashionable one, and in a way, I think we just didn't notice that we'd kind of gotten to the end of a generation. And so there was a new generation that was maybe disconnected from the old users. And they found other sources. Heroin's a lot cheaper than it used to be.

REUTERThe price declined throughout the 80s and the early 90s, and that didn't make much difference, but it has become a not very expensive habit now. So, that probably helps increase the use amongst young people who just don't know much about it.

NNAMDIHere is Bob in Eastern Maryland. Bob, you're on the air. Go ahead, please.

BOBThank you, Kojo. It's a pleasure to be here. As a life long musician in the D.C. area, and also a non-user, but a very avid observer of people and their drug habits, I can say, unequivocally, that the price of Oxycontin, when the regulatory agencies started throttling back on the manufacturers and the medical community as to their prescription writing, and the manufacture of Oxycontin, heroin, all of a sudden, became the cheap alternative. And coupled with the fact that, I don't want to get into politics, but the Afghan issue, and Iranian issue, is a key source of their revenue, their terrorist revenue.

BOBSo, they're flooding the US market with heroin, or opiates. And the US manufacturers of prescription drugs had been throttled back, accordingly. So, the alternative is, these kids that used to be able to go out and buy an Oxycontin for three or four or five dollars, now are spending 25 dollars, and you can buy a bag of heroin for dirt cheap. So, there's no question that the preponderance and the experience of overdoses is gravitating towards heroin now.

NNAMDIThe point that Peter Reuter was making earlier, that heroin today is relatively inexpensive, but Cynthia, can you talk a bit about how high schools are dealing with this and educating students? Education is what your organization is focused on.

TUOHYWell, I don't know -- I can't tell you what the high schools are doing currently. I can tell you what a good model is for high schools to use. And that is to have student assistance professionals at the high schools and the middle schools. And part of what student assistance professionals do is that they teach, make aware, educate around drug issues, around family dynamics. A lot of children move into using because they come from family systems that are using.

TUOHYAnd so it's an environmental impact that needs to be addressed, not just a biochemical impact. And so I think student assistance professionals in the schools, I think the ability to have kids that they can go to, peers that are natural helpers that they can talk to, kids don't always feel comfortable talking to adults. So, you know, set up -- there are systems where you can set up peer supports in schools and people can talk about these issues.

TUOHYI think in health classes it's important to talk about the dynamics of alcohol and other drugs on the brain, and help kids understand this is your brain. You only get it once. You only get one brain. They haven't learned how to transplant that yet. And it's important to understand it to the point that you can take better care of it and also to understand the dynamic of addiction and that addiction, particularly with heroin, is about 23 percent of people who use heroin becomes addicted to it, becomes dependent on it.

TUOHYAnd so, that's a pretty high percentage, that's almost one out of four. And when you start asking yourself -- when you're growing up and you start asking yourself, what are the risk factors that I have, it's important to be able to know those risk factors and be able to make better decisions based on that information.

NNAMDICynthia Moreno Tuohy is the executive director of NAADAC, the Association of Addiction Professionals. Peter Reuter is a professor of public policy and criminology, director of the Center of Economics of Crime and Justice Policy at the University of Maryland. He's also the co-founder and senior economist with the RAND Drug Policy Research Center. Thank you both for joining. We're going to be taking a short break.

NNAMDIWhen we come up -- when we come back, we will be looking at the tragic fallout after a leading sports website outed a transgender interviewee. I'm Kojo Nnamdi.