Relief, without Remedy:The Return of Heroin

Terrence D. Walton, MSW, CSACDirector of Treatment

Pretrial Services Agency for the District of Columbia

WHAT IS A DRUG?

Any substance that alters mood, level of perception, and/or brain functioning

Getting the Inteneded Effect

Bottle to Blood to Brain Route of Administration:

Smoke Sniff Snort Shoot Swallow

The Blood Brain Barrier Neuro-compatibility

The Great Debate:Who is the MAC Daddy?

1. Power (receptor affinity)2. Popularity (acceptability)3. Presence (accessibility)4. Pay off (onset & intensity)5. Persistence (length of high)6. Patterns (of use)7. Penalty (onset & intensity)

Mood Altering Chemicals

1. Legal & Illicit 2. Street Drugs and

Prescribed Drugs3. Hard Drugs & Soft

Drugs4. Very Addictive &

Less-Addictive5. Natural and

Synthetic

1. Stimulants2. Depressants3. Opioids4. Cannabinols5. Hallucinogens/

Dissociatives6. Inhalants/

Deliriants/Other

Prevalence Number of those 12 and over using heroin rose from 373,000

in 2007 to 669,000 in 2012

Number of those 15 to 24 dying of heroin overdose rose from 198 in 1999 to 510 in 2009.

Drug overdose was the leading cause of injury death in 2010. Among people 25 to 64 years old, drug overdose caused more deaths than motor vehicle traffic crashes.

ER visits for opiate misuse doubled from 2004 to 2008 (CDCP 2010)

Prescription drugs (mostly opiates) are the 2nd most commonly abused drugs—behind only marijuana (ONDCP 2007)

Prevalence Those under 18 are

among the fastest growing group misusing

Opiates (Vicodin) number one abused prescription drug among adolescent 12th graders—9.7%

Prescription opiate abuse up 345% between 1998-2010

Heroin is a narcotic that is highly addictive; It is processed from morphine, a naturally occurring substance extracted from the seedpod of the Asian poppy plant.

The most abused and most rapidly acting of the opiates.

Usually seen as a white or brown powder or as a black sticky substance. The differences in color are due to impurities left from the manufacturing process or the presence of additives.

Pure heroin, which is a white powder with a bitter taste, is rarely sold on the streets.

Sometimes cut with other substances such as sugar, powdered milk, cornstarch, or even poisons like strychnine.

Heroin: The Basics

H Smack Junk Horse China white Black tar Brown Skag

Street Names

Injection, smoking, snorting The user feels the effect of heroin

within seconds of taking it. Heroin is converted into morphine when it enters the brain, which disrupts normal brain activity and creates intense feelings of pleasure.

Routes of Administration

Euphoria Warm flushing of the skin Dry mouth Heavy extremities Decreased mental ability Insensitivity to pain Vomiting Lowered breathing Lowered heart rate

Typical Acute Effects

Death By Overdose

Addiction High degree of tolerance Brain damage Arthritis Liver disease Infection of the heart lining HIV/AIDS or hepatitis Abscesses of the skin (at injection sites)

Potential Chronic Effects

Death By Overdose,

Disease, Suicide, Injury, Violence

Heroin can cause severe physical and psychological symptoms 6 to 8 hours after the last dosage. Painful withdrawal gets worse as time passes.

Symptoms Include: Runny nose muscle and bone pain Emotional distress and restlessness Diarrhea Vomiting Hot flashes and heavy sweating Cold flashes with goose bumps Insomnia An overwhelming need for more heroin

Withdrawal

The Old Dealers

The New Dealers

Addiction is a Brain Disease

Any use causes acute and

temporary changes and prolong use

changes the brain in fundamental,

destructive and long lasting

ways

What is AddictionA brain based disorder

associated with impairment within the

brain’s reward center that impacts brain executive functions and results in compulsive, repetitive,

self-destructive behaviors

How Drugs Work

Interact with neurochemistry

Results:Feel Good – euphoria/reward

Feel Better – reduce negative feelings/relief

Opiates Provide BothRelief & Reward

Drug-Interacting Neurotransmitters

Dopamine – excitement & reward

Serotonin – feel – “normal” GABA – lowers anxiety Endorphin/Enkephalin –

pain relief, reward, craving

Dishonorable Mentions Desomorphine (Krokodil)

Zohydro (hydrocodone-based)

EBT

Manuals

BestPractice

Outcomes

Science

Effective Practices

CognitiveBehaviora

l Treatment

12 StepPreparation

Relapse Preventio

n

Medication

Assisted Treatment

Co-OccurringDisorders

Medication Assisted Treatment Goals

1) To provide relief from withdrawal symptoms

2) To reduce craving

3) To prevent drugs from working ~ occupies receptor (antagonist)

4) To provide replacement ~ activates receptor (agonist)

Pharmacological Interventions Naltrexone – Interrupts actions of

opiates (partially blogs alcohol); reduces cravings (antagonist)

Methadone – Opiate addiction – reduces craving, mediates withdrawal symptoms, helps restore normal functioning (agonist)

Buprenorphine (Subuxone) – similar to methadone, may be prescribed by an MD with special training (partial agonist)

Emergency Overdose Intervention

Naloxone

A Big Resource

National Registry of Evidenced-based Programs and Practices:

www.nrepp.samhsa.go

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Relief, without Remedy:Prescription and Illicit Opiate Abuse

Terrence D. Walton, MSW, CSACDirector of Treatment

Pretrial Services Agency for the District of Columbia

Terrencewalton@aol.com