Community Prevention 1

Community Prevention of Heroin Use

Community Prevention of Heroin Use

Amanda North

SUNY Polytechnic Institute

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Community Prevention of Heroin Use

Substance abuse disorders have a powerful effect on the health of individuals, their

families, and the communities in which they live. In 2014, an estimated 22.5 million Americans

aged 12 years and older reported needing treatment for alcohol or illicit drug use (Prevention of

Substance Abuse and Mental Illness, 2015). By 2020, mental and substance use disorders will

surpass all physical diseases as a major cause of disability worldwide, these disabilities result in

a significant cost to families, employers, and publicly funded health systems (Prevention of

Substance Abuse and Mental Illness, 2015).

The National Institute on Drug Abuse has reported that 20% of people ages 12 and older

have admitted to using prescription drugs for nonmedical reasons at least once in their lifetime

and close to 14% of these people are said to meet the criteria for abuse of, or dependence upon it

(Oneida County, 2016). Education and action needs to occur in order to bring this information to

the public to make a change.

CommunityAssessment

In 2015, 35% of the Oneida County Residents who admitted to substance abuse

problems, admitted to using heroin (Oneida County, 2016). In 2015 alone 3000 Oneida County

residents were admitted for substance abuse treatment, 35% of which were heroin users (Roth,

2016). From 2013-2015, there was a reported 77 opioid related deaths, 46 of which were from

Heroin, adding to what is considered a local heroin epidemic (Oneida County, 2016).

Itisnotonlyadultsthatareeffectedbythisepidemic,the Oneida County Health

Department reports that although the overall illegal drug use amongst youth is lower in Oneida

County as compared to national statistics, there has been a startling discovery in their results

(Health Profile, 2011). 0.5% of 7th graders and 1.6% of 11th graders have reported that they use
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heroin everyday, creating a three-fold increase in illegal drug use for 11th graders as compared to

7th graders (Health Profile, 2011).

Due to these statistics, it was clear that creating a teaching project on heroin use was

needed in order to make the community aware of not only the statistics, but the factors that can

lead to heroin use and the individuals that can be effected.

Heroin Use Background

Opioid dependency is one of the oldest and widespread drug problems around, aside from

alcohol abuse. Opioids are a class of drugs that include prescription pain relievers hydrocodone,

oxycodone, morphine, fentanyl, codeine and others; it also includes the illicit drug heroin

(Opioid Addiction, 2016). In 2012 alone, 259 million prescriptions were written for opioids,

which would be enough to give every American adult their own bottle of pills (Opioids, 2016).

This is an astonishing statistic and appears to have a direct impact on the heroin epidemic that is

being faced.

Four out of five heroin users started out by misusing prescription pain medications that

were either prescribed to them or obtained illegally. Opioid drug users report switching to heroin

once they built up a tolerance to these medications because prescription opioids are harder to

obtain and are far more expensive (Opioid Addiction, 2016). Heroin is a drug that is synthesized

from morphine, a natural substance that is extracted from the Asian opium poppy plant, and can

be injected, snorted, or smoked (Goldenburg, 2014). When heroin enters the brain, it is converted

back to morphine, activating the mu-opioid receptors (MORs) which are located in the reward

center of the brain that is responsible for the release of dopamine that provides the rush of

pleasure that users report experiencing (Goldenburg, 2014). The MORs that are activated are not

only located in the reward center of the brain, they are also located in the brain stem, which
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controls the automatic processes that regulate blood pressure, arousal, and respirations

(Goldenburg, 2014). In the case of a heroin overdose, the MORs in the brainstem is deregulated

causing a suppression of breathing that can be fatal (Goldenburg, 2014). Regular heroin use

changes the functioning of the brain, causing heroin tolerance, dependence, and addiction, 23%

of individuals who use heroin become addicted (Goldenburg, 2014).

Heroin injection puts a person at an increased risk for contacting HIV and Hepatitis C,

these diseases are transmitted through blood or other bodily fluids and can occur when needles or

other drug injecting materials are shared (Havens, Oser & Leukefeld, 2011). Heroin abuse is also

linked with a number of other serious health conditions that can include, abscesses, arthritis,

bacterial infections, collapsed veins, infection of the heart lining and valves, liver and kidney

disease, and spontaneous abortion (Havens, Oser & Leukefeld, 2011).

Treatment for heroin includes both behavioral and pharmacological treatments, and for

the majority of people, a dual therapy plan is most effective. Behavioral therapies can be

delivered in the outpatient or residential care settings and can include cognitive-behavioral

therapy, motivational interviewing, and contingency management. The medications used to treat

the symptoms of withdrawal include methadone, buprenorphine, and naltrexone (Mogali et al.,

2014). Rapid naltrexone induction as a form of detoxification has been proven to be effective as

a precursor to naltrexone therapy, but it has been proven to be less effective in younger

populations and in those that have a greater dependence on heroin (Mogali et al., 2014).

No matter the treatment path, it is pertinent that heroin users have an effective treatment

plan that not only addresses the symptoms of heroin intoxication and withdrawal, but also

focuses on the addictive disease itself in order to promote success (Goldenburg, 2014). Persons

with prescription opioid dependency may have a more promising long-term outcome as
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compared to heroin users as non-heroin users showed an improvement from their baseline after

opioid addiction treatment whereas heroin users showed a worsening course (Weiss et al., 2015).

Education

The focus of our education was based on the prevention of heroin use by preventing

opioid use. The information above was presented to the community, along with the introduction

of Katies story (Appendix 1) letting the community know that opioid drug use and abuse can

happen to anyone and can start with something as innocent as taken prescription pain medication

for an injury.

Goals for the Teaching/Learning Experience

The goals for the teaching/learning experience for the Community Prevention of Heroin

Use was to focus on the interventions that can occur before heroin use starts, such as protecting

and not sharing your opioid medication. To be able to prevent heroin deaths by educating the

community members on what a heroin overdose may look like with signs and symptoms

including slow and shallow respirations, pale skin, being non-responsive, and seizures

(Goldenburg, 2014). It was also a goal to educate as to what they should do if they suspect

someone is suffering from an overdose, such as immediately calling 911. We also set out to

develop an awareness of the health consequences that can come from improper use of

prescription drugs and how it can lead to heroin addiction.

Learner Outcomes

The learning outcomes that were set out for the community members were for them to be

able to identify that heroin can be injected, snorted or smoked, to be able to identify the signs and

symptoms of heroin overdose, and to be able to identify two ways in which they can help

someone who is suspected to be suffering from a heroin overdose. It was also of great
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importance for us to have the community members take the prescription pledge (Appendix 2) to

keep their prescriptions safe in order to prevent heroin use.

The best way to reduce the prescribing of opioid medications and to prevent abuse is by

educating providers to follow evidence-informed prescribing guidelines. The National Institute

on Drug Abuse has developed 12 Centers of Excellence in Pain Education that trains providers in

this area (Compton, Boyle & Wargo, 2015). The focus cannot be based solely in the prescribing

of these medications; it also needs to have a focus on primary prevention. Treating current opioid

use disorders and focusing on overdose prevention is key as it can reduce the demand for the

drugs and reduce overdose mortality, interventions specifically aimed at youth have proven to be

effective (Compton, Boyle & Wargo, 2015).

Analysis

The teaching project was highly effective. Most people from the community has heard of

the heroin epidemic that Oneida County and the country is currently facing, but they were

unaware that most heroin users began by using opioid pain medication. At the end of the

presentation the community member was asked to complete a quiz that assessed the knowledge

retained, in a multiple choice format the learning outcomes were tested. Of those who completed

the quiz, it was noted that the majority of the information was retained, and when an answer was

incorrect, they were provided with the correct response. After the quiz, we asked that each

community member take a pledge to end prescription medication abuse (Appendix 2) in order to

protect themselves and others. Each community member that took the quiz completed the pledge

as well.

The poster board presentation was strong in terms of drawing the community members

attention with bring colors and graphics, it was able to catch their eye enough for us to make the
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needed contact to start presenting the education. Also, I think that offering Katies story

(Appendix 1) allowed us the opportunity to make opioid drug abuse and heroin use more

relatable in terms of letting them know that drug abuse and addiction can happen to anyone at

anytime.

The major weakness that I found to be present with this presentation was being able to

make contact with enough community members to educate them. With all of the other

presentations, it was very busy and loud, so it was hard at times to keep someones attention.

In order to improve upon this project I would enlarge some of the content on the board in

order to make it easier to read and I would also try to make the presentation more interactive in

order to attract more community members to the presentation. After the presentation I pondered

the possibility of adding questions to the board that would require the member to move in order

to find the answer, this would allow me to connect with more people.

Conclusion

It has been proven that heroin use most often initiates after a tolerance to opioid pain

medication is built. It is of great importance that prescription opioid medication is taken as

directed and is not shared with anyone else. If these medications are used only as prescribed and

are kept safe from anyone who should not have access to them it would be rational to think that

this heroin epidemic that is being faced could be lessened. It is also important as future Nurse

Practitioners that we take the role of prescribing these medications with prudence and only

prescribe the minimum number of pills that will be required and if long term use is needed, a

narcotic contract needs to be signed by the patient in order to ensure proper use. Every heroin

overdose can be prevented.

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References

Compton, W. M., Boyle, M., & Wargo, E. (2015). Prescription opioid abuse: Problems and

responses. Preventive Medicine, 80, 5-9. doi:10.1016/j.ypmed.2015.04.003

Goldenburg, M. (2014). Patient education: 11 common questions on heroin abuse. Psychiatric

Times, 1-4.

Havens, J. R., Oser, C. B., & Leukefeld, C. G. (2011). Injection risk behaviors among rural drug

users: Implications for HIV prevention. AIDS Care, 23(5), 638-645.

doi:10.1080/09540121.2010.516346

Health Profile. (2011). Retrieved April 01, 2016, from

http://www.ocgov.net/oneida/sites/default/files/health/CommunityHealthAssessment/Hea

lth Profile .pdf

Mogali, S., Khan, N. A., Drill, E. S., Pavlicova, M., Sullivan, M. A., Nunes, E., & Bisaga, A.

(2014). Baseline characteristics of patients predicting suitability for rapid naltrexone

induction. The American Journal on Addictions Am J Addict, 258-264.

doi:10.1111/j.1521-0391.2014.12180.x

Roth, A. N. (2016, April 15). Oneida County taking new approach to heroin problem. Retrieved

April 18, 2016, from http://www.uticaod.com/article/20160415/NEWS/160419662

Oneida County, NY. (2016, April 14). Retrieved April 16, 2016, from

http://www.ocgov.net/node/2495

Opioid Addiction. (2016). Retrieved April 01, 16, from http://www.asam.org/docs/default-

source/advocacy/opioid-addiction-disease-facts-figures.pdf

Prevention of Substance Abuse and Mental Illness. (2015). Retrieved April 01, 2016, from

http://www.samhsa.gov/prevention

Tavitian-Exley, I., Vickerman, P., Bastos, F. I., & Boily, M. (2015). Influence of different drugs
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on HIV risk in people who inject: Systematic review and meta-analysis. Addiction,

110(4), 572-584. doi:10.1111/add.12846

Weiss, R. D., Potter, J. S., Griffin, M. L., Provost, S. E., Fitzmaurice, G. M., Mcdermott, K. A., .

. . Carroll, K. M. (2015). Long-term outcomes from the National Drug Abuse Treatment

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Alcohol Dependence, 150, 112-119. doi:10.1016/j.drugalcdep.2015.02.030

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Appendix 1
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Appendix 2
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