1. HEROINES FIGHTINGHEROIN 1
Heroines Fighting Heroin
A Review of the Literature
Seungin Baek, Michelle Forero, Stephanie Galindez, Janine Leverich,
Dysiris Mateo, Taylor Whitehouse, Mallory Woltering
Stony Brook University
Author Note
This paper was prepared for Professional Writing 383, Section 2, taught by Professor
Peterson.
Abstract
Recent statistics have shown that Long Island, New York, is experiencing a heroin
epidemic. It is imperative that methods of prevention be implemented immediately in order to

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stop the current situation from getting worse. Heroines Fighting Heroin is a program that will
increase prevention and subsequently reduce the number of heroin users on Long Island. With
the highest percentage of heroin users falling between the ages of 12 and 19, the target
population will be teenagers beginning their ninth-grade school year. Heroines Fighting Heroin
will use a variety of techniques to educate teenagers in order to prevent them from using heroin.
A specific combination of surveys, mandatory weekly classes run by guest speakers, weekly
visits to a drug rehabilitation center, and one-on-one time with recovering addicts will provide a
program that is successful at educating the students while reducing the amount of heroin abuse in
Long Island teens. Anonymous surveys that the students will take at the beginning and end of
the school year will provide a precise measurement of the program’s success. Heroines Fighting
Heroin seeks to obtain a grant of one million dollars, which would be necessary to fund this
extensive prevention program and allow for immediate implementation in Long Island high
schools.
Heroines Fighting Heroin
A Review of the Literature
Introduction
In recent years, there has been a significant rise in the prevalence of heroin use and
heroin-related deaths on Long Island. In the past, heroin was a drug popular among an older

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population. However, the Long Island Council on Alcoholism and Drug Dependence (LICADD)
has reported a dramatic and fatal increase of heroin use and addiction amongst the teenage
population. The LICADD reports that the drug has not only increased in purity and accessibility
but has also dropped in cost. A majority of the cases of heroin abuse have been seen among
teens of middle class parents who were completely unaware of their child’s drug addiction. The
statistics necessitate the desperate need for an effective program to combat this epidemic.
Heroines Fighting Heroin is the program that will facilitate a change amongst teens on Long
Island. This program moves to raise awareness of this issue amongst susceptible teenagers
through the incorporation of education and hands-on interaction. The main goal of this program
is to increase the prevention and attentiveness of heroin use in Long Island teens. Through the
implementation of Heroines Fighting Heroin in Long Island high schools, great improvements
can be achieved.
Identification of the Population Served
The rise in heroin use amid the adolescent population necessitates the need for a program
which focuses on education and prevention targeting this age group. Research indicates that
adolescents ranging from the ages of 16 to 19 are amongst the group most susceptible to heroin
abuse. Researchers suggest that there are many factors which contribute to drug addiction and
heroin use among the teenage population. Dryfoos (1990) examined the inability of teenagers to
execute responsible decision making. She explained that underprivileged teenagers typically
lack a positive support system that emphasizes the value of responsibility and education. This
lack of responsibility in teens often leads to drug use, participation in criminal activities,
promiscuous behaviors, and teen pregnancy. Other factors that contribute to the use of heroin

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among the teenage population include gender, race, socioeconomic status, geographic location,
and previous criminal record (p. 4).
Ethnicity has also been recognized as a prevalent factor involved in the use of heroin.
Heroin use through venous injection is most common amongst the Caucasian population.
Statistics show that 48% of the Caucasian population is addicted to heroin. In comparison, only
22% of the African-American population is heroin dependent. Maccoby found that on average,
heroin use begins between the ages of 17 and 19 amongst these two populations (Leukefeld,
1990, p. 199). Berke and Harlow (2014) of CNN news explained that heroin use on Long Island
begins as early as the age of 12 (para. 8).
There are many factors that are said to have contributed to the heroin epidemic on Long
Island. Berke and Harlow (2014) suggested that the nearness and access to major airports
facilitates the ease and frequency with which drugs are transported (para. 8). This may be a
contribution to the increased prevalence of heroin on Long Island. Another factor that has
impacted the cause of this epidemic is the leniency with which painkillers are prescribed on
Long Island. Many heroin addicts explain that their addiction began with painkillers. However,
reduced accessibility and increased cost of prescription pills has led teens to resort heroin. The
availability, effects, and cheap cost of heroin are all factors that aide in teens’ attraction to the
drug. In four years, drug use on Long Island has increased by 45% (Berke & Harlow, 2014).
The Drug Enforcement Agency (DEA) has made several heroin-related arrests on Long Island.
In addition, there has been a significant increase in heroin-related deaths among Long Island
teens. As Burke and Harlow (2014) stated in their CNN news article, Jeff Reynolds reflects on
the death of actor, Philip Seymour Hoffman, stating, “We probably could have prevented most
of those overdoses, through prevention, access to treatment, recovery support. Yet we didn't. So

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each one is an indictment of what we failed to do. But it also should energize us to say we need
to get serious about this disease" (para. 14). This program, Heroines Fighting Heroin, intends to
combat and improve the heroin use among Long Island teens through education and prevention
methods aimed toward the targeted population.
Documentation of Statistical and Demographic Information on the Issue
Over the course of many decades, substance abuse has been a persistent problem
worldwide. However, heroin has played a prominent role in the increased rates of substance
abuse on Long Island. The effects of the heroin epidemic have caused an array of problems and
turmoil among communities and families all over Long Island. The statistics and demographics
of heroin use have drastically changed over the years in regard to gender, location, race, age, and
first use of opioids (Cicero, Ellis, Surratt, and Kurtz, 2014, para. 4).
Within the late 1900s, heroin was heavily used amongst people who lived within the
cities (Cicero et al., 2014, para. 5). A majority of heroin users during this time were minorities
(Cicero et al., 2014, para. 5). During this time period, heroin users first started experimenting
with the drug in their mid to late teenage years. (Cicero et al., 2014, para. 5). The users of heroin
were mostly common amongst males within this population (Cicero et al., 2014, para. 5).
Cicero et al. (2014) stated that in recent years, the statistics and demographic information
regarding the use of heroin has changed. Heroin has become more prevalent in suburban areas,
where, in the past, the drug was typically found in inner cities. The prevalence and accessibility
of heroin in suburban areas has increased. In turn, the use of the drug has increased among the
Caucasian populations that inhabit these areas. Heroin use has actually increased in age; Heroin
users usually start using the drug around the age of 22. Recently, heroin use has been
predominant among females and males where, in the past, heroin use was most common among

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males. Men and women who are using heroin began their substance abuse using prescription
drugs. For multiple reasons, these people have resorted to heroin (para. 5).
Cicero et al. (2014) also concluded that the change in the statistics and demographics of
heroin can be most attributed to economics. Within the recent decade, heroin users began using
prescription drugs (para. 29). However, over time, prescription drugs became very expensive
and users sought another drug that would afford them the same effect at a lesser price (Cicero et
al., 2014, para. 27). In addition, Long Island pharmacies implemented strict regulations on the
administration of prescription drugs, which increased the user’s difficulty of accessing these
drugs (Brandstrom, 2013, para. 1). In turn, heroin has now become the most prevalent drug due
to its widespread accessibility (Cicero et al., 2014, para. 5). Toman stated, “on Long Island a
bag of heroin is being sold for only $7, while a bundle of heroin is going for $80” (Finn, 2013,
para. 3, 5).
Long Island has become a prime location in the heroin epidemic. The increased
availability and use of heroin on Long Island has had life altering and fatal consequences on
families and communities. Martin, (2014) reported that heroin-related deaths have reached a
record high within the years 2012 and 2013, and heroin has taken the lives of over 240 people
within Suffolk and Nassau County (para. 10). There were nearly 1,000 heroin overdoses in
Nassau County in the year 2013 alone (Martins, 2014, para. 11). These facts support the
substantial need for the implementation of Heroines Fighting Heroin. As the years go on,
heroin-related deaths, overdoses, and arrests are continuing to rise (Martins, 2014). Many avid
heroin users were motivated young people with a good life and positive support system (Martins,
2014, para. 17). Heroin is making its way through Long Island and defusing quickly (Finn,
2013, para. 1).

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Heroin has become a major epidemic, not only on Long Island, but within the United
States as a whole. As stated in an article from the National Institute on Drug Abuse, “according
to the National Survey on Drug Use and Health (NSDUH), in 2012 about 669,000 Americans
reported using heroin in the past year, a number that has been on the rise since 2007” (What is
the scope of heroin in the United States, 2014, para. 1). Stated in the USA TODAY, “all told,
heroin and related opioid pain pills have killed more than 125,000 in the U.S. in the past 10
years” (USA TODAY, 2014, para. 7). The statistical facts of this major national issue further
support the need for Heroines Fighting Heroin in Long Island high schools.
Discussion of Health Concern or Disease
Heroin, scientifically known as diacetylmorphine hydrochloride, has become a major
health concern in the United States. It has been noted that a majority of heroin users have started
with opioid pill use. Opioid prescription pill abuse became prevalent in the late 1990s when
pharmaceutical companies began producing hydrocodone and oxycodone. It was shown that
OxyContin, an “extended release formulation of oxycodone,” provided intense chronic pain
relief (Mars, 2013). Mars, Borugois, Karandinos, Montero, and Ciccarone (2013) conducted a
study in Philadelphia and San Francisco to gauge how opioid prescription pill abuse has led to
heroin use. Most heroin users are prescribed “short-acting oxycodone with acetaminophen” (e.g.
Percocet) or “extended release oxycodone” (Mars et al., 2013, p. 260). Mars et al. (2013)
investigated how pill users delved into heroin use by explaining that “for pill initiated began with
chewing pills or crushing them to a powder and sniffing or smoking them. This was often
followed by sniffing or smoking heroin and then by injecting it” (p. 261). According to Gruber,
Silveri, and Yurgelun-Todd (2007), oxycodone is referred to as an opiate agonist that “attaches
to a receptor and produces an action that either mimics or potentiates the action of the

8. HEROINES FIGHTINGHEROIN 8
endogenous compound” (p. 300). A “rush” has been ascribed to opiate use, which involves a
brief but euphoric state of relaxation. This state is caused when “opioids bind with opiate
receptors, which are found in many regions of the brain” (Gruber et al., 2007, p. 300). Opiate
agonists are associated with the mu receptor. Gruber et al. (2007) found that “the mu1 subtype is
found outside the spinal cord for central interpretation of pain and the mu2 subtype is found in
the central nervous system and causes respiratory depression, spinal analgesia, bradycardia,
physical dependence and euphoria” (p. 300). The relationship between opioids and heroin comes
down to a psychological and physiological effect.
Heroin use has become more popular in the last decade due to its low cost and fast high
compared to opioid pills. Heroin and oxycodone both derive from morphine. Heroin, in contrast
to morphine, can cross the blood-brain barrier faster and result in an intense high. LeVert (2006)
discusses the variety of ways heroin can be used amongst which include the injection through
hypodermic needles, snorting of the powder, smoking it by breathing in the heated powder, or by
swallowing it (pp. 19, 20). Heroin, like opiates, attach to opioid receptors in the brain causing a
depression in the central nervous system characterized by slow heart rate, slow respiratory rate, a
drop in blood pressure and a lowered mental capacity (LeVert, 2006, p. 20). Heroin user’s
dependency and tolerance causes the intense withdrawal symptoms. The main reason that heroin
addicts continue to use it is to avoid the detrimental, severe withdrawal symptoms. According to
Schwartz (1998), withdrawal symptoms begin about 8 hours after the last intake, where acute
withdrawal symptoms occur between hours 48 and 72. This includes agitation, anxiety,
piloerection, tachycardia, mild hypertension, and pupillary mydriasis, itchy skin, irritability, and
insomnia (Schwartz, 1998).

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Death due to heroin overdose has become a major issue. Warner-Smith, Darke, Lynskey,
and Hall (2001) investigated the causes and consequences of heroin overdose. Warner-Smith et
al. (2001) believed that “long-term users may be at higher risk of overdose as the result of a
reduction in the difference between the dose required to achieve the desired effects and the dose
sufficient for lethal respiratory depression” (p. 1116). The physiological effects of heroin
overdose are edema, arrhythmia, acute cardiomyopathy, rhabdomyolysis, and potentially
hypoxia (Warner-Smith et al., 2001). Heroin use can have an overwhelming negative effect on
the human body due to its addictive qualities, long-term physiological problems, and risk of
overdose. In turn, raised awareness and prevention of the use of this drug in teens is necessary
and achievable through Heroines Fighting Heroin.
Program components
Trending data shows that Long Island, New York is currently plagued with some of the
highest rates of heroin abuse in the country (Frank, 2000, p.5). Given this information, this
program will move to directly address this epidemic. Heroines Fighting Heroin is a two-step
program which focuses on prevention of heroin use among high risk teens. The effective method
of incorporating education and real life experience will work to create a lasting impact on the
students.
Part one: Education
A mandatory weekly class will be incorporated into the school curriculum of the first
semester of the academic year for ninth grade students. During the first class, students will
partake in an anonymous survey. The survey will include questions such as, “have you ever used
drugs?”, “what drugs would you experiment with?”, “what is your knowledge of heroin?”, as
well as, “do you know anyone that has ever used heroin?” The answers to this survey will not

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only introduce the topic to the students, but will also provide the instructor with the student’s
relevant background as well.
Throughout each class, students will not be lectured by a teacher, but rather a guest
speaker. Guest speakers will consist of recovered heroin addicts, family and friends of previous,
current and deceased heroin addicts, police officers and DEA agents. The students will not have
any homework or exams, but rather will be asked to write an anonymous yet personal reflection
in response to each of the guest speakers. Their reflections will discuss how the speaker made
them feel as well as explain if, and how, the speaker changed their understanding of heroin or
their likelihood of trying the drug. This will provide the instructor with a better understanding of
what specific issues need to be focused on in class. A heavy emphasis is placed upon the
anonymity of the reflections and surveys. In turn, an honest and open environment will be
encouraged and facilitated among the students.
Part Two: Practical Experience
In the second semester, students will visit a drug rehabilitation center once a week, where
they will be paired with a recovering heroin addict. The recovering addict will be known as the
“heroine” and they will act as a mentor, spending supervised one-on-one time with the students
while they battle their addiction and strive to reach sobriety. The heroines are instructed to
honestly explain to the students what it is like to use heroin, how it has affected their lives, how
it feels to be high, and the severe physiological and psychological effects of withdrawal. The
students will be afforded a visual of life as a drug addict, life in a drug rehab and possibly even
life in prison. The heroines will delineate how their addiction has affected their life, the lives of
their family and friends, their social relationships, as well as their mental and physical health.

11. HEROINES FIGHTINGHEROIN 11
Students are encouraged to develop educational relationships with their heroines. At the end of
the semester, students will be required to write a personal letter to their heroine, explaining how
their heroine has or has not changed their opinion of heroin use. Students will end the semester
with completing the same anonymous survey that they completed on day one. Responses will be
compared to evaluate the effectiveness of this program and identify the need for appropriate
adjustments.
The personal time students spend with their heroine will be constantly supervised by law
enforcement and medical staff. Although the heroines are voluntary participants, they will be
screened to guarantee they are not a physical danger to the student participants. Parental waiver
forms will be required for all students. Heroines will also sign a waiver, granting the students
permission to personally discuss their story and health information with peers, family, friends
and classmates as to ensure the privacy of the recovering addicts.
Heroines Fighting Heroin may seem to share similar components with other programs
such as “Scared Straight”. However, Robinson and Slowikowski (2011) explained that scared
straight programs are not only ineffective; they actually increase participants’ likelihood of
participating in drugs and criminal behavior (para. 8). The difference between our program and
programs like Scared Straight is that this program repeatedly exposes students to their heroines
who will guide and advise the students rather than intimidate them. Robinson and Slowikowski
(2011) demonstrated that repeated mentor-led exposure is proven to be far more effective than
singular, “scary” experiences (para. 9). This information proves the validity of this program.
With this information, we altered our program to address the inefficiencies in prior similar
programs. In order for this program to effectively develop and be successful, a grant of one
million dollars is necessary. The funds will be put towards facilitating safe transportation and

12. HEROINES FIGHTINGHEROIN 12
legal protection of both the students and the rehab participants, as well as cost associated with
school district fees for implementing the program. This program will directly tackle heroin use
and addiction among the Long Island population, resulting in a significant reduction in heroin
abuse and heroin related deaths and an increase in awareness and prevention.
Conclusion
The foundation of the Heroines Fighting Heroin program was built on copious research,
evaluation and analysis of data. Heroin has posed a detrimental and fatal problem on Long
Island as well as throughout the United States. Factors regarding the use, accessibility and cost
of this drug have significantly changed over the years, reinforcing the need for this program.
This program aims to raise awareness and increase preventative methods amongst Long Island
teens. In doing so, great reform regarding the heroin epidemic on Long Island can be achieved.

13. HEROINES FIGHTINGHEROIN 13
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