After more than 20 years in psychiatry, Dr. Rajesh Parekh is witnessing a new and disturbing trend among patients who come for help with drug addiction.

"Twenty years ago I would see an adolescent a few times a year," said Parekh, attending psychiatrist at the Care Plus outpatient program in Groton, part of Natchaug Hospital. "Now it's a few times a month."

The reason? Too many teenagers are abusing prescription opiate painkillers like Percocet, getting addicted, then turning to heroin.

"Heroin is cheaper and it stops the painful withdrawal symptoms (from prescription opiates)," said Parekh. "But I try to tell them, whatever pain you had when you started, the pain of heroin is much worse."

Despite the long and well-known history of its dangers, heroin has seen a recent resurgence in popularity and with it, the ruined lives and physical damage that go with the addiction. Oftentimes, addicts come to Parekh after ending up in the hospital emergency department because of an overdose. During an overdose, breathing muscles became paralyzed and "respiratory depression" sets in.

"For some it can be a wake-up call," he said.

Dr. Martin Maloney of Coastal Behavioral Health in New London said that in his 20 years as a psychiatrist, he's never seen the heroin problem worse than it is now. It's a cheap, easily accessible substitute that people are turning to after getting addicted to prescription painkillers after surgery, he said.

"People are spending $400 to $1,000 a week on heroin, and end up dealing drugs, stealing or turning to prostitution to support it," he said. "It destroys people's lives. Drugs are so prevalent, and there's this nonchalant attitude about it."

Heroin is one of the most powerful addictions because of the unique way the drug interacts with the brain, Parekh explained. When the drug enters the body, either through the nose or by injection, it couples onto specific opiate receptors in the brain and - initially - relieves pain and produces pleasure.

"But as you constantly expose your body tissues, you create more receptors so you need more and more to get the same effect," he said. "Your tolerance builds."

As the addiction deepens, the body "starts fighting back" anytime there's an interruption in the heroin supply. Withdrawal symptoms become overwhelming.

"The autonomic nervous system gets excited," Parekh said. "You'll get muscle spasms, sweating, the blood pressure elevates, the pulse goes up, the piloerector muscles (the ones that cause goose bumps and hair standing on end) get agitated, you get diarrhea, abdominal cramping. There's so much pain."

Addicts end up doing almost anything to stop the pain. At this point, using heroin brings no pleasure, but "just stops the discomfort of not using it," he said.

"Maintaining their drug use becomes their lifestyle," he said. "They end up stealing from stores, their own family, taking other people's medications. They spend all their time trying to cop the drugs. It becomes their job."

He's seen patients who've lost families and jobs and ended up homeless and struggling with depression on top of their addiction.

"You give up everything, and for what?"

The good news, according to Parekh and Maloney, is that there are effective treatments to help people break their addiction. Both psychiatrists are prescribing Suboxone, an antidote that came into wider use about five years ago, in combination with group and individual therapy.

"Within a week on Suboxone, people have no more cravings," said Maloney, who received his federal license enabling him to prescribe the drug six months ago. "People who are vested in getting better and whose families are vested in them getting better do very well. Suboxone is a lifeline."

A daily dose of Suboxone costs about $10. An initial appointment with a private practice psychiatrist can cost $150 to $200, and follow-up evaluations run $75 to $150, Parekh said. But patients who balk at the cost need only be reminded how much they had been spending on heroin, Parekh said.

In addition to prescribing Suboxone, and having patients submit to regular urine tests to ensure they are taking the drug rather than diverting it for street sale, his office runs two Suboxone support groups. One of the keys to success for patients, he said, is that they erase all their cell phone and computer contacts with heroin suppliers and friends who are users.

"Once they see a name, it can be a trigger," he said. "I tell them they have to stay away from people and places and things that can be triggers. I have people who've been in treatment for six months to one year to four years."

Overall, both psychiatrists want the public to know that there is help available to beat heroin addiction.

"I want people to know about treatment," Parekh said.

j.benson@theday.com