1. Heroin Opiates and
Violence in Our
Communities
Bethany Anderson, MPH
Injury Prevention Coordinator
Howard University Hospital
Department of Surgery
Division of Trauma and Critical Care
2. What are Opiates?
There are three primary types:
1. Natural
2. Synthetic
3. Semi-synthetic
3. How are Opiates Used?
Four most common ways of use:
1. Injection
2. Oral consumption
3. Transdermal patch
4. Suppository
8. Heroin and Violence
Continual use leads to a greater likelihood of violent thought and subsequent
violent behaviour.
The increase in violence in the US trends with the increase in heroin use
nationwide.
10. What is Narcan?
Opiate antidote
Naloxone drug family
Nasal spray or injection
Prescription medicine that BLOCKS the effects of opioids and REVERSES an
overdose.
CANNOT be used to get high
Has no effect on someone who has not taken opioids
11. How YOU Can Make a Difference
When asked, drug users indicate they are willing to give naloxone to each
other.
The availability of naloxone (Narcan) does not increase the use of heroin.
There are Narcan distribution programs that offer overdoes prevention and
recognition training
These programs also offer a prescription of take-home Narcan
There are more than 100 programs in 15 states including DC
13. Bethany Anderson, MPH
Injury Prevention Coordinator
Howard University Hospital
Department of Surgery
Division of Trauma and Critical Care
beanderson@huhosp.org
(202) 865-7110
Editor's Notes
Opiates come from a group of drugs called narcotics and are derived from the opium poppy which is widely grown in Afghanistan. There are three primary types of opiates:
Natural opiates such as codeine & morphine – occurring naturally in the opium poppy and doesn’t need any method of compounding to produce the drug. These are used exactly how they are when taken from the plant and have analgesic effects without being mixed with other substances.
Synthetic opiates such as methadone & fentanyl – man-made and not from the opium poppy at all. They have no opium or opiate derivatives, but have a similar effect. These include fentanyl, methadone, and Demerol – all widely used in the medical world for pain treatment.
Semi-synthetic opiates such as Oxycodone & Hydrocodone – not naturally occurring, but do have opiate derivatives. They have a similar chemical makeup, but they are synthesized in a laboratory. Semi-synthetic opiates is the category drugs such as heroin (a street drug) and hydrocodone (a commonly prescribed drug) fall into.
Opiates are most commonly used in one of the four ways:
Injection – among addicts, injection is the most common method of use. Heroin morphine and dilaudid are often injected
Smoking opiates such as heroin is also common, but usually addicts choose to inject because smoking progresses to a state of greater physical dependency.
Oral consumption – prescribed opiates are usually taken by the mouth. Some addicts will crush and eat the pills to make the effects of the pill come on stronger OR some will crush and snort the pills for a near immediate rush to the brain – these ways of taking opiates pose extreme risk
Transdermal patch – the patch is stuck to the lower back, arm, upper hip or another part of the body where it provides a low-grade administration over a long period of time – when not used correctly, this form of use poses a huge risk
Suppository – not the most common form of opiate use – drug is inserted in rectum, vagina, or urethra
Heroin can be injected, inhales or smoked – all three routes deliver the drug to the brain rapidly and contributes to health risks and risk of addiction
Some immediate effects of heroin use is insomnia and constipation. Lung complications such as pneumonia and tuberculosis are usually an effect of lowered respiration. Many experience mental disorders such as depression and antisocial personality disorder. Men experience sexual dysfunction while women experience irregular menstrual cycles.
Long-term effects of heroin use include damage to the mucosal tissues in their nose as well as perforated nasal septums (the tissue that separates the nasal passages).
Medical consequences include (for injections) soft tissue infections, scarred or collapsed veins, bacterial infections of the blood vessels and heart valves, abscesses (or boils).
In street heroin, additives may include substances that do not readily dissolve and thus result in clogging the blood vessels that lead to the lungs, liver, kidneys or brain. This can cause infection or even death of small patches in cells of organs that do vital work in the body.
Immune reactions can cause arthritis or other rheumatologic problems.
Sharing injection equipment or fluids can lead to hepatitis B and C, HIV, and other blood-borne viruses that can be easily transmitted to sexual partners AND children.
Things that promote survival and breeding in the brain – such as eating and sex – trigger a region in your brain for dopamine neurotransmitters. This is the pleasure center of the brain. Heroin triggers this same part of your brain, but the dopamine surges from the drug are faster and long-lasting. Repeated use leads to the neurotransmitters becoming exhausted from stimulation and the brain dampens the dopamine response (to ALL pleasurable behaviour, not just drugs) – this results in people seeking bigger dopamine responses. Drug users seek larger and larger hits to achieve the same high they initially, which is constantly diminishing. Eventually, constant use rewires the brain structurally.
Crime is substantially up in many urban centers and while it can be blamed on drug cartels and their links to local gangs, this is a longstanding relationship. Since 2014, violent drug-related crimes have spiked and can be lined to heroin. Heroin attracts a wider range of customers resulting in wider turf wars resulting in higher rates of violence. But its not THAT simple. Studies have linked heroin use (both prescribed and street) to increased violence.
In 1979 Mirin and Meyer said "Under conditions of chronic heroin use, the direct effects of drug administration on mood significantly change. The euphorigenic effects of opiates are often replaced with feelings of confusion, hostility, and suspicion."
Over time, research has seen the trends of violence in conjunction with the uptick in heroin use and can be safely linked together.
Narcan™ (naloxone) is an opiate antidote. Opioids include heroin and prescription pain pills like morphine, codeine, oxycodone, methadone and Vicodin. When a person is overdosing on an opioid, breathing can slow down or stop and it can very hard to wake them from this state. Narcan™ (naloxone) is a prescription medicine that blocks the effects of opioids and reverses an overdose. It cannot be used to get a person high. If given to a person who has not taken opioids, it will not have any effect on him or her, since there is no opioid overdose to reverse.
side effects: Patients who experience an allergic reaction from naloxone, such as hives or swelling in the face, lips, or throat, should seek medical help immediately. They should not drive or perform other potentially unsafe tasks. Use of naloxone may cause symptoms of opioid withdrawal, including:
Feeling nervous, restless, or irritable
Body aches
Dizziness or weakness
Diarrhea, stomach pain, or nausea
Fever, chills, or goose bumps
Sneezing or runny nose in the absence of a cold
Giving naloxone to overdosing people has not resulted in dangerous health outcomes for that person; (b) Drug users are willing to give naloxone to each other; (c) Naloxone availability does not increase drug use. (d) Thousands of opioid overdoses have been reversed with naloxone. In the United States, Narcan™ (naloxone) distribution programs generally provide overdose prevention and recognition training along with a prescription of take-home Narcan™ (naloxone). More than 100 programs that distribute naloxone to opiate users are operating in at least 15 states including DC.
In an effort to save more lives from opioid overdose, SAMHSA published the Opioid Overdose Prevention Toolkit – 2014. The Toolkit equips communities and local governments with material to develop policies and practices to help prevent opioid-related overdoses and deaths. It also serves as a foundation for educating and training:
Communities
Prescribers of opioid pain medications
First responders
Patients who are prescribed opioid medications
Individuals and family members who have experienced an opioid overdose
SAMHSA is also working with its federal partners and state and local law enforcement to expand the safe administration of naloxone by first responders.
SAMHSA is working with emergency medical service professionals to:
Identify any state or local laws that permit or restrict naloxone use by certain types of first responders
Advocate for their use of naloxone in emergency situations
