Israel’s illicit NIS 6 billion drug market includes approximately 100 tons of marijuana annually entering the country, primarily through the Egyptian border, about three tons of cocaine via Lebanon and Jordan, and up to four tons of heroin, from Lebanon and Egypt.According to the Anti-Drug Authority, addiction to narcotics in Israel transformed from a “marginal concern” in the 80s, to ensnaring some 25,000 full-blown addicts, largely due to Western influences and greater access.Among all addicts in the country, approximately 8,300 are presently undergoing treatment at a rehabilitation facility, although the success rates are not very high, with only one-third being fully rehabilitated.“They need between one and three doses of drugs a day, usually heroin,” the authority said.And although the numbers pale in comparison to other Westernized countries – such as the United States, where a recent study by the Office of National Drug Control Policy states there are 1.5 million “chronic heroin users” – heroin has nonetheless found its way into Jerusalem.While there are no statistics indicating the precise number of heroin addicts in Israel, Elad Borovsky, a clinical social worker who has been an acting manager of Talpiot’s Jerusalem Methadone Center for three years, says that addiction to the powerful drug has become a “major problem” in the capital.“There’s a strong connection between drugs and mental health situations,” said Borovsky on Monday. “If a person is already using drugs to deal with experiences like heavy trauma or depression, 60-70 percent will eventually use heroin to deal with the problem. The Methadone Maintenance Program operated by the Association for Public Health is the end of the chain of treatment for substance-abuse issues, especially for heroin addicts who failed to wean from the drug.”Borovsky said roughly 350 patients visit his clinic (100 patients daily) to receive carefully administered doses of the drug, as well as Suboxone, to meet with social workers for individual and group therapy, and physicians overseeing their treatment.Approximately 70% of patients are Jewish, and 30% are Arab residents of the capital, he said, adding that 80% are men and 20% are women.The average age for men at the clinic is 45 to 50, and the average for women is 30 to 35. The clinic is operated by the Association of Public Health, while the Health Ministry helps subsidize treatment costs.The common denominator among the patients, Borovsky said, is that all of them began using drugs or alcohol at early ages.“By age eight or nine, they began smoking cigarettes or drinking alcohol, then at between ages 13 to 15 they started to use hash and marijuana, and most of them started heroin by age 18 or 19,” he said.While Borovsky is careful to note that the majority of young recreational users of marijuana, hash or alcohol will not move onto heroin, he said that all addicts at the clinic started with those substances.“There is a depressive reaction for some people… and they need something stronger to contain it, and lots of them had a story where they began using heroin and became quote ill,” he said. “And when they saw a physician, they were told that they were going through withdrawal.” Heroin, he emphasized, is the only drug that elicits physical symptoms during withdrawal.“There’s sweating, yawning, nausea, diarrhea, and aches all over the body – especially in the joints,” he said. “It creates physical trauma that they describe it as something that is unbearable.”Moreover, Borovsky said that withdrawal can result in complications, including heart disease and diabetes.“Once you start taking heroin, you have to use it approximately every four hours, and increase the dose as their tolerance to the drug increases,” he said.Methadone, he continued, has proven most effective in replacing heroin, thus allowing physicians to administer increasingly lower doses until the symptoms are contained.“Neurologically, methadone grabs the same receptors, so according to the brain, it is the same thing as heroin, but it has three main advantages,” Borovsky said.“The first advantage is that the dose is stable… usually averaging between 80 mg. to 100 mg. a day. The second is that it is supposed to stay in your body between 24 to 36 hours, so the person doesn’t need to think all the time about where they’re going to get their next dose.”The third advantage, he continued, is that patients can take it orally, in liquid form.“The great thing about not injecting is that it helps them avoid contracting diseases through needles,” he explained.A common misconception about methadone, Borovsky added, is that it is only administered temporarily.“Patients will have to continue to come in everyday for 15 to 20 years, and take the same dose,” he said. “The monitoring and behavioral changes are the main goal.”Asked about the prevalence of heroin in Jerusalem, Borovsky said the market itself has improved considerably over the past 30 years, when a greater supply infiltrated the country through Lebanon and Egypt.However, despite greater security checks at borders, which have largely prevented most heroin drug mules from entering Israel, Borovsky said that new synthetic drugs and legally-prescribed opiates are creating great risk of eventual heroin addiction.“Things today have changed,” he said.“There is much less heroin on the market now, but there are a lot of synthetic versions and opiates, including Percocet, OxyContin, Oxycodone etc. that are prescribed by family doctors, which are used by addicts like pure heroin. Some of them contain codeine, some of them contain morphine, but the functioning is the same as heroin.”Indeed, Borovsky said that legally-prescribed pain-relief drugs have ensnared an unwitting new population of addicts, who are at risk to move on to heroin after the doctors cut them off.“This is a new phenomenon, where normative people who are successful for some reason get injured in an accident for example, and become addicted to the morphine,” he said. To ensure compliance with their treatment, Borovsky said the Health Ministry enforces strict codes of conduct, including ceasing to use all drugs except for methadone or Suboxone.“The methadone doesn’t make patients feel high, it stabilizes them,” he explained. “So once they come here, they need to give up all other drugs.”However, he noted that roughly 20-30% of patients continue to use cocaine, synthetic drugs or opiates during the first year treatment.Despite the common prescriptions of opiates for pain management, Borovsky said he does not hold the doctors prescribing them responsible for ongoing addiction.“Family doctors are dealing with a lot of problems and a lot of pressure from these patients,” he said. “It is very complicated; they are demanding and they are suffering, so they are putting a lot of pressure on them. So we work in cooperation with them to stop the prescriptions and seek treatment.”Equally alarming, he said, is that young people who buy dangerous synthetic drugs like “Nice Guy” from kiosks – or are simply prescribed stimulants like Ritalin unnecessarily, and become addicted – are at risk becoming heroin addicts in the future.“Even though we only treat adults, a lot of times parents are calling us to ask what to do [with children using drugs],” he said. “Those things that give them euphoria and feeling disconnected from real life result in going onto harder drugs, like heroin. It’s like a chain reaction.”For now, Borovsky said the best preventative measures and treatment involves a comprehensive approach, addressing not just the psychological underpinning of addiction, but education, particularly among youth.