Prescription drug abuse is a growing trend. In fact, following marijuana and alcohol, prescription and over-the-counter drugs have become the most commonly abuse substances by Americans over the age of 14.* Preventing or stopping prescription drug abuse is an important part of patient care. View this informative guide now to learn what you need to know about prescription drug abuse, heroin abuse and treatment options.

1. IS YOUR PATIENT ABUSING OR MISUSING
PRESCRIPTION DRUGS?
KNOW THE SIGNS.
A GUIDE TO UNDERSTANDING
PRESCRIPTION DRUG ABUSE
AND THE ROAD TO HEROIN.

2. 2
IS YOUR PATIENT ABUSING OR MISUSING PRESCRIPTION DRUGS? KNOW THE SIGNS.
A GUIDE TO UNDERSTANDING PRESCRIPTION DRUG ABUSE AND THE ROAD TO HEROIN.
877-505-HOPE (4673) | RecoverGateway.org
Page
Contents
Prescription Drug Abuse is a Growing Trend.....3
Risks Associated with Prescription Drug Abuse.....4
Commonly Abused Prescription Drugs.....5
Signs and Symptoms of Prescription Drug Abuse.....5
Link to Heroin.....6
What is Heroin?.....7
What Does Heroin Look Like?.....7
Teen Heroin Use.....8
Signs and Symptoms of Heroin Abuse.....8
Long-Term Effects of Heroin Abuse.....9
Heroin and the Brain.....9
Treatment for Heroin Abuse.....10
Evidence-Based Practices.....10
The Joint Commission Accreditation.....12
About Gateway Alcohol & Drug Treatment Centers.....13

3. 3
IS YOUR PATIENT ABUSING OR MISUSING PRESCRIPTION DRUGS? KNOW THE SIGNS.
A GUIDE TO UNDERSTANDING PRESCRIPTION DRUG ABUSE AND THE ROAD TO HEROIN.
877-505-HOPE (4673) | RecoverGateway.org
Page
The National Institute on Drug Abuse (NIH) found that,following marijuana
and alcohol, prescription and over-the-counter drugs have become the
most commonly abused substances by Americans 14 and older.*
The process of becoming dependent on prescription drugs can begin
easily and often,innocently.“Sometimes,your patients may not finish their
medication and might give it away to others who need it, or the person’s
children or other family members may find it,” explains Carl Scroggins,
Overdose Prevention Programs Supervisor at Gateway.
According to the NIH, these drugs are often perceived as safer than illicit
drugs but,when abused,pose serious health risks including overdose.The
National Institute on Drug Abuse (NIDA) found that more people die from
prescription opioid overdose than all other drugs combined.
*The National Institute of Health (NIH) - 2015
Where Are Prescription Drugs Obtained?
3.9%
Drug dealer or stranger
1.9%
From more than one doctor
0.3%
Purchased Online
Source: Drug Abuse.gov
18.1%
From one
doctor
54.2%
FREE from
friend or
relative
16.6%
Bought/took from
friend or relative
5%
Other
The majority of unprescribed drugs are
obtained from friends or relatives.
adults in the U.S. have
abused prescription drugs
in their lifetime. Source: NSDUH
Prescription Drug Abuse is a Growing Trend

4. 4
IS YOUR PATIENT ABUSING OR MISUSING PRESCRIPTION DRUGS? KNOW THE SIGNS.
A GUIDE TO UNDERSTANDING PRESCRIPTION DRUG ABUSE AND THE ROAD TO HEROIN.
877-505-HOPE (4673) | RecoverGateway.org
Page
The risks associated with prescription drug abuse vary depending upon
the drugs that are abused. Abuse of opioids/narcotics/pain relievers can
result in life-threatening respiratory depression (reduced breathing).
Risks Associated with Prescription Drug Abuse
If your patients abuse depressants
including benzodiazepines, tranquilizers, barbiturates and sedatives, they
place themselves at risk of seizures,respiratory depression and decreased
heart rate.
Stimulant abuse can cause
high body temperature, irregular heart rate, cardiovascular system failure
and fatal seizures.It can also result in hostility or feelings of paranoia.
If your patients abuse prescription drugs
by injecting them, they can be exposed to additional risks, including
contracting HIV (human immunodeficiency virus), hepatitis B and C and
other blood-borne viruses.

5. 5
IS YOUR PATIENT ABUSING OR MISUSING PRESCRIPTION DRUGS? KNOW THE SIGNS.
A GUIDE TO UNDERSTANDING PRESCRIPTION DRUG ABUSE AND THE ROAD TO HEROIN.
877-505-HOPE (4673) | RecoverGateway.org
Page
The commonly abused prescription drugs in the United States fall into
several broad categories.
Your patients may abuse these drugs because they are an easily accessible
and inexpensive means of altering a user’s mental and physical state; the
effects vary depending upon the drugs they abuse.
Commonly Abused Prescription Drugs
Painkillers
Vicodin,Tylenol with Codeine,OxyContin,Percocet
Depressants
Klonopin,Nembutal,Soma,Valium,Xanax
Stimulants
Adderall,Concerta,Dexedrine,Ritalin
•• Constricted pupils,slurred speech
•• Personality changes,mood swings,irritability
•• Excessive energy,avoiding sleep
•• Sweating,flushed skin,loss of appetite
•• Forgetfulness,sleepiness and clumsiness
•• Patients claiming to losing pills and needed more
Signs and Symptoms of Prescription Drug Abuse
DIDYOU KNOW?
Adolescents are at a greater risk for addiction
to OxyContin than adult users of the narcotic
prescription drug?
If you prescribe medications, it’s important to
know that adolescent OxyContin addiction “results
in lasting functional changes in the developing
adolescent brain.”*
*Source: Neuropsychopharmacology, Sept. 10, 2008 issue published by
Rockefeller University research

6. 6
IS YOUR PATIENT ABUSING OR MISUSING PRESCRIPTION DRUGS? KNOW THE SIGNS.
A GUIDE TO UNDERSTANDING PRESCRIPTION DRUG ABUSE AND THE ROAD TO HEROIN.
877-505-HOPE (4673) | RecoverGateway.org
Page
Research now shows addiction to prescription opioids such as Vicodin and
Oxycontin may open the door to heroin abuse. Making the transition from
one to the other is frequently a matter of economics and accessibility:The
cost of prescription pills is $20 to $60, while the easier to access heroin
sells for $3 to $10 a bag.
In the past five years, heroin use has increased by 75 percent, according
to Substance Abuse and Mental Health Services Administration (SAMHSA).
No longer a predominantly urban issue, its use has mushroomed in the
suburbs, with the greatest increases seen in young adults aged 18 to 25.
Also rising,is the number of heroin overdoses.
“Opioid overdose kills thousands of Americans every year,” Mr. Scroggins
stated.“Many of those deaths might have been prevented by an inexpensive
drug called Naloxone (Narcan®).”
Administered in hospital emergency rooms and at all Gateway locations,
Naloxone can reverse the effect of opioids. Illinois is one of several states
that allows the drug to be prescribed to family members and other third
parties,which can buy precious time before EMT personnel arrives.
Link to Heroin
$20 to $60
Average cost of
prescription pain pills
$3 to $10
Average cost of a bag of heroin
Source: NCADD.org
Heroin and Rx Drug Abuse Is
On The Rise
Secondary Drug
of Choice:
Prescription Drugs
Primary Drug
of Choice:
Heroin
16.5%
17.2%
23.3%
8.8%
9.2%
11.6%
Based on Gateway Alcohol & Drug Treatment Centers trends in
treatment 2012-2014

7. 7
IS YOUR PATIENT ABUSING OR MISUSING PRESCRIPTION DRUGS? KNOW THE SIGNS.
A GUIDE TO UNDERSTANDING PRESCRIPTION DRUG ABUSE AND THE ROAD TO HEROIN.
877-505-HOPE (4673) | RecoverGateway.org
Page
Heroin is the most abused and rapidly acting of the opiates. It has been
classified by the federal government as a Schedule I narcotic with no legal
use. Users most often consume heroin by snorting, smoking or needle
injection.
Highly addictive, about 1 out of 4 people (23%) who use heroin become
dependent on it.
A heroin high generally lasts between 4-5 hours. Users experience a
euphoric“rush,”warming of the skin,dry mouth and a feeling of heaviness
in the extremities.
Fast acting, once a person uses heroin, it enters the brain quickly and
affects the regions responsible for producing physical dependence. After
repeated exposure,heroin users develop tolerance and increase their dose
to achieve the desired high. Thus, the vicious cycle of heroin addiction
begins.
To make matters worse, people who want to quit heroin often find
themselves using again to manage withdrawal symptoms.
What is Heroin?
Heroin is processed from morphine and usually appears as a white or
brown powder. Larger blocks of heroin may also appear as a black sticky
substance called black tar heroin.
What Does Heroin Look Like?
75%
increase in heroin
usage in the past
5 years (SAMHSA)

8. 8
IS YOUR PATIENT ABUSING OR MISUSING PRESCRIPTION DRUGS? KNOW THE SIGNS.
A GUIDE TO UNDERSTANDING PRESCRIPTION DRUG ABUSE AND THE ROAD TO HEROIN.
877-505-HOPE (4673) | RecoverGateway.org
Page
Why is heroin tempting to teenagers? As prescription opiates become
harder to obtain and more expensive, users of opiates are migrating to
a cheaper, stronger alternative to prescription pills: heroin. 24% of high
school students have abused addictive prescription drugs,a 33% increase
in 5 years.
Teen Heroin Use
• Today’s portrait of a typical heroin user probably isn’t what
most people imagine.The growth in heroin use is primarily
among white, middle and upper class 18-22 year olds,
living in America’s suburbs and rural areas.
• An increase in teen heroin use is an unfortunate outcome
of another sweeping drug abuse trend among affluent
teens: abuse of prescription pain medications, such as
Vicodin and Oxycontin.
Signs and Symptoms of Heroin Abuse
•• Withdrawal from friends and family; spends more time with
new friends.
•• Stealing or borrowing money from loved ones,or unexplained
absence of valuables.
•• Wearing long pants or long sleeves to hide needle marks,even
in very warm weather.
•• Poor performance in school or work.
•• Decreasing attention to hygiene and physical appearance.
•• Shallow breathing and shortness of breath.
•• Clouded mental functioning.
•• Uncontrollable feelings of itching.
•• Constricted pupils.
•• Substantial increase in time spent sleeping.
•• Increase in slurred or incoherent speech.
33%
increase in addictive
prescription drug abuse
among high school students
in the past 5 years

9. 9
IS YOUR PATIENT ABUSING OR MISUSING PRESCRIPTION DRUGS? KNOW THE SIGNS.
A GUIDE TO UNDERSTANDING PRESCRIPTION DRUG ABUSE AND THE ROAD TO HEROIN.
877-505-HOPE (4673) | RecoverGateway.org
Page
RISKS OF USING HEROIN
• Heroin users do not know the purity of the
heroin they are using–so both new and
experienced heroin users can easily overdose.
• The impact of heroin use is more unpredictable
when used with alcohol or other drugs.
• Heroin overdoses–which can result whether
the drug is snorted, smoked or injected–can
cause slow and shallow breathing,convulsions,
coma and even death.
• Heroin can kill. Heroin is one of the most
frequently reported drugs by medical
examiners in drug abuse deaths.
The long-term effects of heroin abuse invade your patients emotional
health.As dependency worsens,your patient may lose the ability to handle
stress or make decisions without the“support”from a heroin high.Job loss,
financial ruin, relationship problems and arrest for crimes committed to
feed the addiction are not uncommon.
After repeated exposure, heroin users develop tolerance, which means
they must increase their dose to achieve the desired high.Once tolerance
develops, users no longer experience the heroin high they once did.
Oftentimes,abusers with a heightened tolerance continue using heroin to
simply feel normal and avoid the discomfort of withdrawal.
Long-Term Effects of Heroin Abuse
Heroin enters the brain quickly. It slows down the way a person thinks,
slows down reaction time and slows down memory.This affects the way
one acts and makes decisions.
When heroin enters the brain, it is converted to morphine and binds to
receptors known as opioid receptors. These receptors are located in
many areas of the brain (and in the body), especially those involved in
the perception of pain and in reward. Opioid receptors are also located
in the brain stem–important for automatic processes critical for life, such
as breathing (respiration), blood pressure and arousal. Heroin overdoses
frequently involve a suppression of respiration.
Heroin users also experience severe heroin cravings during withdrawal,
which can precipitate continued abuse and/or relapse. Major withdrawal
symptoms peak between 48 and 72 hours after the last dose of the drug
and typically subside after about one week. Some individuals, however,
may show persistent withdrawal symptoms for months. Although heroin
withdrawal is considered less dangerous than alcohol or barbiturate
withdrawal, sudden withdrawal by heavily dependent users who are in
poor health is occasionally fatal.
Heroin and the Brain

10. 10
IS YOUR PATIENT ABUSING OR MISUSING PRESCRIPTION DRUGS? KNOW THE SIGNS.
A GUIDE TO UNDERSTANDING PRESCRIPTION DRUG ABUSE AND THE ROAD TO HEROIN.
877-505-HOPE (4673) | RecoverGateway.org
Page
As much as you may want a patient who abuses heroin to seek addiction
treatment,similar to other medical treatments,you can’t force your patient
to get help.
As a medical professional you can only encourage your patient to consider
substance abuse treatment as an option. Recovery will come, only if and
when the substance abuser truly decides to seek a healthier lifestyle.
It’s important that when referring a patient to treatment for prescription drug
or heroin abuse, your referral is to a reputable organization that utilizes
evidence-based practices and is accredited by The Joint Commission.
Evidence-based counseling and therapies include treatments that
integrate professional research and clinical expertise to achieve the best
outcome for your patient.
Treatment for Heroin Abuse
Medication Assisted Treatment
Research shows that medication assisted treatment (MAT) helps patients
remain drug and alcohol free.
Treatment for dependency on opiates, alcohol or other substances can
include the use of a few medications,including Vivitrol®
and Suboxone®
.
In addition to prescribed medications, it’s important that the patient
receives counseling to help increase their motivation for recovery and
enhance overall quality of life. It also helps patients develop the skills
needed to recognize events that may trigger their use of drugs or alcohol
and how to cope with those situations in a healthy way.
Evidence-Based Practices

11. 11
IS YOUR PATIENT ABUSING OR MISUSING PRESCRIPTION DRUGS? KNOW THE SIGNS.
A GUIDE TO UNDERSTANDING PRESCRIPTION DRUG ABUSE AND THE ROAD TO HEROIN.
877-505-HOPE (4673) | RecoverGateway.org
Page
Motivational Interviewing
Motivational Interviewing has strong scientific support for being a highly
effective therapy for those with a substance abuse problem.
Counselors assist patients in exploring their core values and deeply held
goals. These values and goals are usually inconsistent with continued
substance abuse, so they become the guiding force toward behaving in a
way that is consistent with positive,healthy living.
12-Step Facilitation and 12-Step Recovery
•• Explains the concepts of the twelve-step approach used to
assist in recovery.
•• Actively supports initial involvement in AA/NA.
•• Reduces anxiety about attending meetings.
•• Facilitates participation and helps individuals learn to turn
to AA/NA as a resource in times of crisis.
Family Counseling and Education
Family Counseling sessions address family situations caused by substance
abuse. Issues are addressed in an open and respectful atmosphere.
Licensed counselors listen to the challenges family members have been
experiencing, and teach coping skills. The counselor sheds light on how
to support a chemically dependent family member and explains what to
expect in recovery.
Family Education helps family members learn about the addiction process,
heal past harms and build supportive relationships. Family Education
lessons vary to meet specific group and individual family needs. Family
concerns in dealing with addiction are addressed to improve recovery
support, such as: stages of abuse and change, how treatment works,
stages of family recovery,family roles and communication skills.

12. 12
IS YOUR PATIENT ABUSING OR MISUSING PRESCRIPTION DRUGS? KNOW THE SIGNS.
A GUIDE TO UNDERSTANDING PRESCRIPTION DRUG ABUSE AND THE ROAD TO HEROIN.
877-505-HOPE (4673) | RecoverGateway.org
Page
The Joint Commission Gold Seal of Approval™
is an internationally
recognized symbol of quality. Organizations that earn the Gold Seal have
met rigorous performance standards to obtain this distinction by becoming
accredited.
Specially trained health care professionals who are experts in the field
personally visited this drug treatment facility to conduct a review that
monitors how well the staff:
The Joint Commission Accreditation
As of 2009, only 30% of all behavioral healthcare organizations maintain
the standards to receive this accreditation.
All Gateway Alcohol & Drug Treatment Centers are licensed by the state of
Illinois and accredited by The Joint Commission.
•• Provides a safe environment for your care
•• Educates you about the risks and options for your diagnosis
and treatment
•• Protects your rights as a patient,including your privacy rights
•• Evaluates your condition, before, during and after diagnosis
and treatment
•• Protects you against infection
•• Plans for emergency situations

13. 13
IS YOUR PATIENT ABUSING OR MISUSING PRESCRIPTION DRUGS? KNOW THE SIGNS.
A GUIDE TO UNDERSTANDING PRESCRIPTION DRUG ABUSE AND THE ROAD TO HEROIN.
877-505-HOPE (4673) | RecoverGateway.org
Page
Gateway Alcohol & Drug Treatment Centers provide substance abuse
treatment services for teens and adults at drug treatment centers
throughout Illinois including Carbondale, Aurora (Fox Valley), Chicago,
River North, Lake Villa (Lake County), Springfield (Central Illinois), and the
St.Louis Metro East area.
Gateway’s outpatient and residential treatment centers are licensed
by the state of Illinois and accredited by The Joint Commission. Each
year, Gateway’s professional clinicians help thousands of individual’s
successfully complete treatment.
Learn more about Gateway’s free, confidential consultation at
RecoverGateway.org, or call (877) 505-4673.
About Gateway Alcohol & Drug Treatment Centers