Heroin use is increasing across all social classes in Onondaga county similar to state and national trends. Two main reasons for this troubling trend are:
Increased use of prescription opiate pain medications
Availability of cheap heroin
What are Opiates and Opioids?
Opiates and opioids are classes of depressant analgesics derived from or chemically similar to substances found in P. somniferum, the opium poppy. They include both naturally occurring and synthetic substances. Opiates are benzylisoquinoline alkaloids, which are found naturally in the poppy plant Papaver somniferum . The psychoactive compounds found in the opium plant include morphine, codeine, and thebaine.
Heroin is illegal in the United States and is both physically and psychologically highly addictive. It can be injected, inhaled or snorted, and is the fastest-acting opioid. Large doses of heroin can cause fatal respiratory depression. Heroin use has been rising since 2007, growing from 373,000 yearly users to 669,000 in 2012, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). An estimated 467,000 people in the US were addicted to heroin in 2012, and heroin overdose death rate quadrupled in a decade to reach 8,300 in the US in 2013.
Prescription pain relievers can be abused illegally for their opioid effects by those without prescriptions or a medical need. Some commonly abused or illegally resold pain relievers include: Hydrocodone (Vicodin), Oxycodone (OxyContin, Percocet, Percodan), Morphine, Codeine and Methadone.
Risk Factors for Heroin Abuse or Dependence
History of alcohol abuse, marijuana, or cocaine
History of prescription opioid pain medications
According to the CDC, the likelihood of heroin addiction doubles with the alcohol use, triples with Marijuana use, increases 15 times over with Cocaine and 40 times over with the use of prescription opiates.
Significant switch in the trends of opioids and heroin: A Public Health Concern
Prescription opiates are the most common substance of abuse and trend is switching to use of prescription and heroin combined.
Fig: National Rates of Abuse of Opioids in the Previous Month among 15,227 Respondents:
Reference: Theodore J Cicero PhD: Shifting Patterns of Prescription Opioid and Heroin Abuse
in the United States: N Engl J Med 2015; 373:1789-1790 October 29, 2015
Today’s heroin is significantly pure. It can be injected, smoked or snorted.
According to the DEA, since 1999, there has been 40 % increase in the purity, which has broadened its appeal to be used either by snorting or smoking.
Inhalation is a common practice now.
Negative Health Consequences of Opioids and Heroin
Strong sense of euphoria, dependence, constipation, sedation, respiratory depression, withdrawl smptoms with abrupt discontinuation and in exteme situation death can occur.
When used intravenously it increases the chance of contracting HIV, hepatitis B and C or developing a bacterial infection. A recent HIV outbreak in Indiana resulted from use of dirty needles is a testimony to this serious threat.
Use during pregnancy results in exposure of babies to these drugs, results in neonatal abstinence syndrome (NAS). There has been a significant increase in incidences of NAS nationally (NEJM).
Increase in fatality due to motor vehicle accidents.
How to Address this Problem
A comprehensive plan in Onondaga County has a three-pronged approach:
PREVENTPeople from Starting Heroin
Reduce prescription opioid painkiller abuse
Improve the prescribing practices of opiates by working with local physicians
Onondaga County Sharps, Needles and Drug Disposal (SNADD) Program
Onondaga County’s new SNADD program offers a solution for the safe disposal of household medications. As a joint effort, the Onondaga County District Attorney’s Office, Onondaga County Health Department, Upstate New York Poison Center, Covanta, OCRRA, REACH CNY, Prevention Network, the Citizen’s Campaign for the Environment, and others have joined together with local participating police departments to install medicine drop boxes at their facilities. Learn more and see media coverage of this event.
Pictured above: Prescription Drug Drop Off Bins located at local Police Departments
Reduce Heroin Addiction by Linking People to TREATMENT
Help those who are addicted get appropriate treatment and crisis intervention.
The current treatment options are:
Naltrexone (short- and long-acting forms)
Contingency management, or motivational incentives
Vivitrol Treatment: This is approved medication and does not require special certification, but it should be only given when counseling support services are established and will continue with the medication.