Relief, without Remedy: The Return of Heroin Terrence D. Walton, MSW, CSAC Director of Treatment...
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Relief, without Remedy:The Return of Heroin
Terrence D. Walton, MSW, CSACDirector of Treatment
Pretrial Services Agency for the District of Columbia
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WHAT IS A DRUG?
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Any substance that alters mood, level of perception, and/or brain functioning
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Getting the Inteneded Effect
Bottle to Blood to Brain Route of Administration:
Smoke Sniff Snort Shoot Swallow
The Blood Brain Barrier Neuro-compatibility
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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)
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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
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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)
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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
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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
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H Smack Junk Horse China white Black tar Brown Skag
Street Names
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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
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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
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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
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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
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The New Dealers
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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
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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
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How Drugs Work
Interact with neurochemistry
Results:Feel Good – euphoria/reward
Feel Better – reduce negative feelings/relief
Opiates Provide BothRelief & Reward
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Drug-Interacting Neurotransmitters
Dopamine – excitement & reward
Serotonin – feel – “normal” GABA – lowers anxiety Endorphin/Enkephalin –
pain relief, reward, craving
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Dishonorable Mentions Desomorphine (Krokodil)
Zohydro (hydrocodone-based)
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EBT
Manuals
BestPractice
Outcomes
Science
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Effective Practices
CognitiveBehaviora
l Treatment
12 StepPreparation
Relapse Preventio
n
Medication
Assisted Treatment
Co-OccurringDisorders
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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)
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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)
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Emergency Overdose Intervention
Naloxone
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A Big Resource
National Registry of Evidenced-based Programs and Practices:
www.nrepp.samhsa.go
v
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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